An audit to assess the adherence to British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines in patients on antiplatelet or anticoagulant therapy in clinical practice in a UK endoscopy service. 

A prospective analysis of patients on anticoagulant and antiplatelet undergoing endoscopy over a period of six weeks from September 2025 at a district general hospital in North London was undertaken.  Electronic patient notes along with the endoscopy reports were scrutinized for management of antiplatelet/anticoagulation during the time of their diagnostic or therapeutic endoscopy and compared to the recommendations according to BSG and ESGE guidance.  

55 patients were included, median age 72 and 62% were male. A low-risk diagnostic endoscopy was performed in 69% of patients, whilst 31% of patients had a high-risk therapeutic procedure which included either polypectomy (n= 16) or oesophageal stricture dilatation (n= 1).  

BSG/EGSE guidelines were followed in 42% of patients. Lower adherence rates were seen in low-risk diagnostic endoscopy (37%).  

Of those having a low-risk diagnostic procedure, 50% of patients stopped their antiplatelet medication unnecessarily; this includes clopidogrel (n= 10), aspirin (n= 5) and dual antiplatelet therapy (DAPT, n= 3). For patients taking DOACs (direct oral anticoagulants), guidelines were not followed appropriately in any of the five patients- three patients did not omit their medication on the morning of the procedure, and two patients omitted them for an unnecessarily long period of time.  

For high-risk therapeutic procedures, BSG/EGSE guidelines were correctly followed in 53% of patients. Non-adherence with guidelines included not discussing strategy for temporarily stopping P2Y12 receptor antagonists with an interventional cardiologist for high-risk conditions (coronary artery stents, n= 3), stopping aspirin unnecessarily prior to procedure (n= 3), and stopping apixaban for 24 hours only, instead of the required 72 hours (n= 2).  

The audit found a significant gap between current practice and best practice guidelines with only 42% following recommendation guidelines. The largest gap identified was the unnecessary cessation of aspirin for both diagnostic and therapeutic procedures, as well as the unnecessary prolonged cessation of P2Y12 receptor antagonists for diagnostic procedures. Of concern was the lack of communication with cardiologists regarding the cessation of dual antiplatelet therapy in high-risk patients.  

Possible reasons for this are that patients are predominantly counselled and booked for procedures by nursing colleagues, who may not be familiar with BSG/EGSE guidance. In addition, patients referred for endoscopic procedures come from multiple referral pathways which may be the reason for variability of practice.   

From this study we recommend better implementation and adherence antiplatelet or anticoagulant therapy for endoscopic procedures.  

The findings of this audit will be presented at the next endoscopy user group meeting to highlight non-adherence to guidelines, and to remind members of the multidisciplinary team of best practice guidance. Patient information leaflets and counselling protocols will be reviewed to ensure they are in-line with BSG/ESGE guidance. The service will be re-audited following these changes.