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JACC WHITE PAPER

Management of Platelet-Directed Pharmacotherapy in Patients With Atherosclerotic Coronary Artery Disease Undergoing Elective Endoscopic Gastrointestinal Procedures

Richard C. Becker, MD^_*,_*, James Scheiman, MD, Harold L. Dauerman, MD, Frederick Spencer, MD, Sunil Rao, MD^||, Marc Sabatine, MD^¶, David A. Johnson, MD^#, Frances Chan, MD^_**, Neena S. Abraham, MD, Eamonn M.M. Quigley, MD in collaboration with the American College of Cardiology and the American College of Gastroenterology

^_* Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
University of Michigan, Ann Arbor, Michigan
University of Vermont, Burlington, Vermont
McMaster University, Hamilton, Ontario, Canada
^|| Durham VA Medical Center, Durham, North Carolina
^¶ Brigham and Women's Hospital, Boston, Massachusetts
^# Eastern Virginia School of Medicine, Norfolk, Virginia
^_** Chinese University of Hong Kong, Hong Kong, China
Baylor College of Medicine, Houston, Texas
National University of Ireland at Cork, Cork, Ireland

Manuscript received June 9, 2009; revised manuscript received September 9, 2009, accepted September 15, 2009.

^_* Reprint requests and correspondence: Dr. Richard C. Becker, Duke Clinical Research Institute, Cardiovascular Medicine, 2400 Pratt Street, Terrace Level, Room 0311, Durham, North Carolina 27705 (Email: becke021{at}mc.duke.edu).

The periprocedural management of patients with atherosclerotic coronary heart disease, including those who have heart disease and those who are undergoing percutaneous coronary intervention and stent placement who might require temporary interruption of platelet-directed pharmacotherapy for the purpose of an elective endoscopic gastrointestinal procedure, is a common clinical scenario in daily practice. Herein, we summarize the available information that can be employed for making management decisions and provide general guidance for risk assessment.

Key Words: coronary heart disease • periprocedural risk assessment • platelet antagonists

Abbreviations and Acronyms   ACS = acute coronary syndrome   BMS = bare-metal stent(s)   CHD = coronary heart disease   CI = confidence interval   CV = cardiovascular   DES = drug-eluting stent(s)   ECG = electrocardiogram/electrocardiographic   ERCP = endoscopic retrograde cholangiopancreatography   ESD = endoscopic submucosal dissection   FNA = fine needle aspiration   GI = gastrointestinal   MI = myocardial infarction   NSAID = nonsteroidal anti-inflammatory agent   OR = odds ratio   PCI = percutaneous coronary intervention   PPI = proton pump inhibitor   RR = relative risk   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction

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