{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 29, Ep 1 of 4: Fasting and Periprocedural Antithrombotics","html":"","width":"100%","height":180,"duration":965,"description":"Episode one of the Endoscopy Practice and Sedation chapter frames the morning of the procedure around two preventable disasters: aspiration and thromboembolism. The organizing idea is that fasting intervals are gastric-emptying kinetics on a clock, and every anticoagulant decision sits at the intersection of procedure bleeding risk and patient thromboembolic risk. That grid tells you who holds, who continues, and who bridges. A single asymmetry runs the antiplatelet decisions: an unrecognized stent thrombosis dwarfs endoscopically manageable bleeding, which is why aspirin usually stays on. Reversal closes the loop, each agent matched to its target.\n \nTopics covered\n\nFasting intervals and delayed-emptying exceptions\nGLP-1 receptor agonists and aspiration risk\nProcedure bleeding risk versus patient thromboembolic risk\nWarfarin holds and morning-of INR\nDOAC holds scaled to half-life and kidney function\nThe narrowing of bridging\nAntiplatelet management after coronary stenting\nReversal agents in active bleeding\n \n \nKey decisions\n\nFollow the two-two-six-eight fasting rule for all sedation depths: clear liquids to two hours, breast milk to four, formula or a light meal to six, a fatty or heavy meal to eight.\nFor elevated-risk GLP-1 patients (active GI symptoms, dose escalation, weekly dosing), give a clear liquid diet for at least twenty-four hours before the procedure while continuing the drug, rather than a reflex hold.\nHold warfarin five days before a high-bleeding-risk procedure and confirm an INR below one and a half the morning of, because prothrombin's roughly sixty-hour half-life is the rate-limiting factor.\nHold apixaban and rivaroxaban one to two days for low-risk and two to three days for high-risk procedures; extend dabigatran holds as creatinine clearance falls since it is renally cleared.\nReserve bridging for high-thromboembolic-risk patients only (mechanical mitral valve, recent stroke or TIA, prior clot on warfarin, recent VTE, severe thrombophilia),...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}