Table 2.

Management of antithrombotic therapy in elective endoscopic procedures with high bleeding risks

Thrombotic risk category	Cardiac events*	Antithrombotic therapy in high bleeding risk elective procedures
Very high	ACS or PCI <6 weeks	Defer procedure
High	ACS or PCI 6 weeks–6 months ago	Defer procedure until >6 months after cardiac event if possible If elective procedure is deemed necessary within 6 months: DAPT Continue aspirin Withhold P2Y12 receptor inhibitors 5 days before Resume P2Y12 receptor inhibitors after adequate haemostasis Warfarin Withhold warfarin 5 days before Resume warfarin after adequate haemostasis Heparin bridging DOACs Withhold DOACs 2 days before Resume DOACs after adequate haemostasis No heparin bridging
Moderate to low	ACS or PCI >6 months ago; stable coronary artery disease	Antiplatelet agents Continue aspirin Withhold P2Y12 receptor inhibitors 5 days before Resume P2Y12 receptor inhibitors after adequate haemostasis Warfarin Withhold warfarin 5 days before Resume warfarin after adequate haemostasis No heparin bridging DOACs Withhold DOACs 2 days before Resume DOACs after adequate haemostasis No heparin bridging

*Current evidence indicates that new generation drug-eluting stents and bare metal stents carry similar thrombotic risks. The risk is highest within the first 6 weeks of PCI. The risk remains high from 6 weeks to 6 months, then remains constant thereafter.^{88 89}

ACS, acute coronary syndrome; DAPT, dual antiplatelet therapy; DOACs, direct oral anticoagulants; PCI, percutaneous coronary intervention.