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Kassa Tameru: Antithrombotic Management in GI Bleeding and Elective Endoscopy
Kassa Tameru/Amin General Hospital
Sep 28, 2026, 15:52

Kassa Tameru: Antithrombotic Management in GI Bleeding and Elective Endoscopy

Kassa Tameru, Medical Director at Amin General Hospital, shared a post on LinkedIn:

“Antithrombotic Management in GI Bleeding and Elective Endoscopy

A. Acute GI Bleeding

Warfarin / Vitamin K antagonists

Do not routinely give FFP to patients with acute GI bleeding on warfarin. Evidence is insufficient to recommend for or against PCC in this setting.

If reversal is required, PCC is suggested over FFP.

Do not routinely administer vitamin K for acute GI bleeding.

Dabigatran

Idarucizumab is not routinely recommended for acute GI bleeding.

Rivaroxaban / Apixaban Andexanet alfa is not routinely recommended for acute GI bleeding.

DOAC reversal with PCC. PCC is not routinely recommended for acute GI bleeding in patients taking DOACs.

Platelet transfusion. Do not routinely transfuse platelets solely because the patient is taking antiplatelet therapy.

Aspirin in Acute GI Bleeding. Secondary cardiovascular prevention. Do not routinely stop aspirin in patients taking ASA for secondary prevention.

If aspirin was interrupted resume aspirin on the day endoscopic hemostasis is confirmed.

B. Elective / Planned Endoscopy

Warfarin:

11. Continue warfarin for elective endoscopic GI procedures rather than routinely interrupting it.

12. If warfarin is interrupted:

Do not routinely use heparin bridging.

DOACs: Temporarily interrupt DOACs rather than continuing them for elective endoscopy.

Antiplatelet Therapy: Dual Antiplatelet Therapy (DAPT)

For patients receiving DAPT for secondary prevention: Temporarily interrupt the P2Y12 inhibitor. Continue aspirin

Single P2Y12 inhibitor: Evidence is insufficient to recommend for or against temporary interruption of the P2Y12 inhibitor.

Aspirin monotherapy: For patients taking ASA 81–325 mg/day for secondary cardiovascular prevention: Continue aspirin during elective endoscopy.

When to Resume Antithrombotics After Endoscopy?

Warfarin: Insufficient evidence to recommend whether to resume the same day versus 1–7 days after the procedure.

DOAC: Insufficient evidence to recommend whether to resume the same day versus 1–7 days after the procedure.

P2Y12 inhibitor: Insufficient evidence regarding resumption the same day versus 1–7 days after the procedure.

Practical Endoscopy Pearls

Acute GI bleed:

Don’t reflexively reverse everything.

Warfarin, then avoid routine FFP/vitamin K;

PCC preferred over FFP if reversal is needed.

DOAC, then routine PCC/andexanet/idarucizumab is not recommended.

Antiplatelet therapy, then no routine platelet transfusion.

Aspirin for secondary cardiovascular prevention, then continue, or resume the day hemostasis is confirmed if interrupted.

Elective endoscopy:

Warfarin, then generally continue; DOAC, then temporarily interrupt; DAPT and continue ASA and interrupt P2Y12 when appropriate; avoid routine bridging.

Important: These recommendations are conditional and often based on very-low-certainty evidence, so the individual thrombotic risk, bleeding risk, procedure type, and indication for antithrombotic therapy remain critical.”

Stay updated with Hemostasis Today.

Acute GI Bleeding antithrombotic management Apixaban Aspirin dabigatran DAPT DOAC Elective Endoscopy FFP GI Bleeding Heparin idarucizumab Kassa Tameru P2Y12 inhibitor PCC Planned Endoscopy Platelet transfusion Rivaroxaban Vitamin K Warfarin
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