Management of Anticoagulation in Patients Who Requiere Colonoscopy or Gastroscopy: Safety and Efficacy of Sodic Bemiparin (Hibor®.

Introduction

Nowadays, most patients under oral anticoagulation treatment (OAT) require invasive procedures such as colonoscopy or gastroscopy. The goals of the management OF OAT are to minimize the risk of thromboembolism and bleeding. Few studies have analyzed the efficacy and safety of low-molecular-weight-heparin (LMWH) in the periprocedure management. We have performed a prospective, observational study to evaluate these parameters using high-dose thromboprophylactic therapy with sodic Bemiparin. (Hibor ®)

Methods

From January 2004 since June 2004, patients under OCT were included before colonoscopy or gastroscopy procedures. Periprocedure prophylaxis consisted on: Acenocoumarol patients: Day -3: withdrawal acenocumarol. Days -2,-1,0: Hibor ®3500 UI/d sc and days +1,+2,+3: Hibor ®3500 U/I + acenocumarol. And day +5: acenocumarol only. Warfarin patients: Días -5,-4: withdrawal warfarin, −3, −2, −1, 0; Hibor ® 3500 UI/d sc, days +1,+2,+3,+4: Hibor ®3500 UI/d sc and warfarin and day +5; warfarin only. Thromboembolic complications and bleeding were recorded in a 3 months follow-up.

Results.

We included 65 patients, 33 women and 32 men. Mean age of women was 72 (range: 50–87) years-old and 72 (range: 39–86) in men. 53 were taken acenocoumarol, and 12 warfarin. OAT indications were: 9 prosthethic mechanical mitral valves 12 prosthetic mechanical aortic valves, 4 with mechanical mitral and aortic replacement, 7 with thrombophilia, 7 with embolic atrial fibrilation/flutter (AF) 18 with isolated AF,1 ischemic cardiomyopathy (IM), 3 with IM and AF and 5 with mitral valvulopathy. 24 gastroscopies and 41 colonoscopies were performed. Mean follow-up was 3 months.

No thromboembolic complications were observed. Only one episode of minor bleeding no related with Bemiparin thromboembolic therapy was recorded. One patient developed pruritus at the punction site. No heparin-related thrombopenia cases were observed.

ConclusionsHigh-dose thromboprophilactic therapy with Bemiparin (Hibor ®) is a safe and effective in periprocedures management in patients under OAT who require gastroscopy or colonoscopy