New Anticoagulants and Antiplatelet Agents

A Primer for the Clinical Gastroenterologist

Parth J Parekh MD; Jonathan Merrell MD; Meredith Clary MD; John E Brush MD; FACC; David A Johnson MD; FACG; FASGE


Am J Gastroenterol. 2014;109(1):9-19. 

In This Article

Abstract and Introduction


The discovery of the first oral anticoagulant, warfarin, was a milestone in anticoagulation. Warfarin's well-known limitations, however, have led to the recent development of more effective anticoagulants. The rapidly growing list of these drugs, however, presents a challenge to endoscopists who must treat patients on these sundry medications. This review is intended to summarize the pharmacological highlights of new anticoagulants, with particular attention to suggested "best-practice" recommendations for the withholding of these drugs before endoscopic procedures.


Warfarin was the mainstay of oral anticoagulant therapy until the recent discovery of more precise targets for therapy. Although warfarin therapy is plagued by a narrow therapeutic index, variable individual metabolic responses, and numerous food and drug interactions, newer agents purport to rise above these setbacks. Furthermore, although the safety of these new drugs compared with traditional therapy has been called into question,[1] their ease of use makes it unlikely that they will disappear.

This review will explore the mechanisms of action and pharmacokinetics of novel anticoagulants and antiplatelet agents. In addition, recommended withholding periods for these drugs for patients undergoing elective endoscopic procedures as well as options for achieving rapid hemostasis in patients undergoing emergent endoscopy.