2022美国胃肠病学会-加拿大胃肠病学会临床实践指南：急性胃肠道出血和内窥镜检查时抗凝剂和抗血小板的管理.pdf

542 CLINICAL GUIDELINES American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period 1 2 3 Neena S. Abraham, MD, MSc (Epi), FACG , Alan N. Barkun, MD, MSc (Epi), FACG, CAGF , Bryan G. Sauer, MD, MSc (Clin Res), FACG , , James Douketis, MD4 5 6 7 8 , Loren Laine, MD, FACG , Peter A. Noseworthy, MD , Jennifer J. Telford, MD, MPH, FACG, CAGF and Grigorios I. Leontiadis, MD, PhD, CAGF9 We conducted systematic reviews of predefined clinical questions and used the Grading of Recommendations, Assessment, Development and Evaluations approach to develop recommendations for the periendoscopic management of anticoagulant and antiplatelet drugs during acute gastrointestinal (GI) bleeding and the elective endoscopic setting. The following recommendations target patients presenting with acute GI bleeding: For patients on warfarin, we suggest against giving fresh frozen plasma or vitamin K; if needed, we suggest prothrombin complex concentrate (PCC) compared with fresh frozen plasma administration; for patients on direct oral anticoagulants (DOACs), we suggest against PCC administration; if on dabigatran, we suggest against the administration of idarucizumab, and if on rivaroxaban or apixaban, we suggest against andexanet alfa administration; for patients on antiplatele