Anticoagulation

Question 1

For patients on warfarin who are hospitalized or under observation w/ acute GI bleeding, we suggest against FFP administration.

Answer 1

conditional, very low evidence

Question 2

For patients on warfarin who are hospitalized or under observation w/ acute GIB, we could not reach a recommendation for or against PCC administration.

Answer 2

N/A

Question 3

For patients on warfarin who are hospitalized or under observation w/ acute GIB, we suggest against the use of vitamin K.

Answer 3

conditional, very low evidence

Question 4

For patients on dabigatran who are hospitalized or under observation w/ acute GIB, we suggest against the administration of idarucizumab.

Answer 4

conditional, very low evidence

Question 5

For patients on rivaroxaban or apixaban who are hospitalized or under observation w/ acute GIB, we suggest against andexanet alfa administration.

Answer 5

conditional, very low evidence

Question 6

For patients on DOACs who are hospitalized or under observation w/ acute GIB, we suggest against PCC administration.

Answer 6

conditional, very low evidence

Question 7

For patients on antiplatelet agents who are hospitalized or under observation w/ acute GIB, we suggest against platelet transfusions.

Answer 7

conditional, very low evidence

Question 8

For patients w/ GI bleeding on cardiac ASA for secondary prevention, we suggest against holding the ASA.

Answer 8

conditional, very low evidence

Question 9

For patients w/ GI bleeding on ASA for secondary cardiovascular prevention whose ASA was held, we suggest the ASA be resumed on the day hemostasis is endoscopically confirmed.

Answer 9

conditional, very low evidence

Question 10

For patients on warfarin undergoing elective/planned endoscopic GI procedures, we suggest warfarin be continued, as opposed to temporarily interrupted (1-7 d).

Answer 10

conditional, very low evidence

Question 11

For patients on warfarin, who hold warfarin in the periprocedural period for elective/planned endoscopic GI procedures, we suggest against bridging anticoagulation.

Answer 11

conditional, low evidence

Question 12

For patients on DOACs who are undergoing elective/planned endoscopic GI procedures, we suggest temporarily interrupting DOACs rather than continuing DOACs.

Answer 12

conditional, very low evidence

Question 13

For patients on DAPT for secondary prevention who are undergoing elective endoscopic GI procedures, we suggest temporary interruption of the P2Y12 receptor inhibitor while continuing ASA.

Answer 13

conditional, very low evidence

Question 14

For patients on ASA 81-325 for secondary prevention, we suggest against interruption of ASA.

Answer 14

conditional, very low evidence