B0283 - Methodological Quality of Clinical Practice Guidelines for the Management of Antithrombotic Agents in Patients Undergoing GI Endoscopy: A Systematic Critical Appraisal Using the AGREE II Tool

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Wojciech C. Blonski, MD, PhD

James A. Haley VA Hospital
Tampa, Florida

Wojciech C. Blonski, MD, PhD¹, Tea Reljic, MPH², Jeffrey C. Gill, MD¹, Rene D. Gomez-Esquivel, MD², Brijesh Patel, MD¹, Ambuj Kumar, MD, MPH³
¹James A. Haley VA Hospital, Tampa, FL; ²USF Health Morsani College of Medicine, Tampa, FL; ³University of South Florida Morsani College of Medicine, Tampa, FL

Introduction: Several published clinical practice guidelines (CPGs) exist for the management of antithrombotic agents in patients undergoing GI endoscopy. However, to date, the quality of such CPGs has not been systematically appraised. The goal of this study was to identify and evaluate the quality of CPGs for the management of antithrombotic agents in peri endoscopic period published within last 6 years.

Methods: A systematic search of PubMed and Embase database was performed to identify eligible CPGs. Any CPGs published between January 1, 2016 and April 14, 2022 addressing management of antithrombotic agents in patients undergoing GI endoscopy were eligible. The Canadian Agency for Drugs and Technologies in Health (CADTH) broad filter for the CPG terms was used since it is the most sensitive filter. The quality of the CPGs was independently assessed by five reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Domain scores were considered of sufficient quality when >60% and of good quality when >80%.

Results: The search yielded 343 citations of which 7 were CPGs and included for the critical appraisal (Table 1) (one CPG was published in two journals). Five CPGs were published by the gastroenterology associations in Europe (n=2) and Asia (n=3) and two in the United States. The overall median score for the AGREE II domains was 100% for scope and purpose, 72% for stakeholder involvement, 86% for rigor of development, 100% for clarity of presentation, 29% for applicability and 89% for editorial independence. Table 1 presents scores for the AGREE II domains for each included CPG.

Discussion: The findings from our study show that the overall methodological quality of the CPGs for the management of antithrombotic agents in patients undergoing GI endoscopic procedures varies across various domains. Only one CPG included patient representatives in the CPG development process. There is a significant scope for improvement for methodological rigor and the applicability.

Authors	Title	Journal	AGREE II scores [%]
Authors	Title	Journal	Scope and purpose	Stakeholder involvement	Rigor of development	Clarity of presentation	Applicability	Editorial independence	Overall
Acosta et al.	The management of antithrombotic agents for patients undergoing GI endoscopy	Gastrointest Endosc 2016 Jan;83(1):3-16. doi: 10.1016/j.gie.2015.09.035.	100%	29%	64%	100%	14%	57%	64%
Kato et al.	Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment: 2017 Appendix on Anticoagulants Including Direct Oral Anticoagulants	Dig Endosc. 2018 Jul;30(4):433-440. doi: 10.1111/den.13184.	100%	57%	64%	86%	29%	79%	61%
Chan et al.	Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines	Gut 2018 Mar;67(3):405-417. doi: 10.1136/gutjnl-2017-315131	100%	86%	79%	100%	14%	100%	73%
Farcas et al.	Gastrointestinal endoscopy in patients on direct oral anticoagulants. A consensus paper of the Romanian Society of Gastroenterology and Hepatology	J Gastrointestin Liver Dis. 2018 Jun;27(2):179-187. doi: 10.15403/jgld.2014.1121.272.end.	100%	57%	71%	71%	29%	86%	61%
Lim et al.	Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy	Clin Endosc. 2020 Nov;53(6):663-677. doi: 10.5946/ce.2020.192	100%	86%	100%	100%	29%	100%	85%
Veitch et al.	Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update	Endoscopy. 2021 Sep;53(9):947-969. doi: 10.1055/a-1547-2282	100%	100%	100%	100%	43%	100%	90%
Abraham et al.	American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period	1. J Can Assoc Gastroenterol.2022 Mar 17;5(2):100-101. doi: 10.1093/jcag/gwac010. 2. Am J Gastroenterol 2022 Apr 1;117(4):542-558. doi:10.14309/ajg.0000000000001627.	100%	100%	100%	100%	57%	93%	83%

Table: Table 1. Clinical practice guidelines included in the critical appraisal using AGREE II instrument.

Disclosures:

Wojciech Blonski indicated no relevant financial relationships.

Tea Reljic indicated no relevant financial relationships.

Jeffrey Gill indicated no relevant financial relationships.

Rene Gomez-Esquivel indicated no relevant financial relationships.

Brijesh Patel indicated no relevant financial relationships.

Ambuj Kumar indicated no relevant financial relationships.

Wojciech C. Blonski, MD, PhD¹, Tea Reljic, MPH², Jeffrey C. Gill, MD¹, Rene D. Gomez-Esquivel, MD², Brijesh Patel, MD¹, Ambuj Kumar, MD, MPH³. B0283 - Methodological Quality of Clinical Practice Guidelines for the Management of Antithrombotic Agents in Patients Undergoing GI Endoscopy: A Systematic Critical Appraisal Using the AGREE II Tool, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.