As endoscopists we frequently encounter patients on anticoagulant and antiplatelet drugs. In these cases we have to balance the risks of discontinuation of these drugs, ie, thrombosis, versus the potentially increased risks of haemorrhage associated with endoscopy if these drugs are continued. There is also the risk of spontaneous gastrointestinal haemorrhage while anticoagulated. Fortunately, we have had useful guidance from national and international organisations.1–3 There have, however, been very few high quality studies on the use of anticoagulants and antiplatelet agents in patients undergoing endoscopy, and consequently the evidence base for much of the advice in these guidelines has been limited. The basic recommendations of these guidelines have remained similar since the American guidelines published in 2002,4 and there have been no published data to challenge these. Indeed, there have been subsequent studies which support some recommendations which were essentially based on expert opinion.

Previous guidelines for anticoagulants relate to the use of warfarin, either continuing it for low-risk (diagnostic) endoscopic procedures, or discontinuing it for high-risk (therapeutic) endoscopic procedures. In …