For patients with a mechanical valve, what is the preferred action before an endoscopic procedure?

For patients with a mechanical heart valve undergoing an endoscopic procedure, the preferred action is to discontinue anticoagulation and consider bridging with heparin. This decision is based on the increased risk of thromboembolic events in patients who are on anticoagulation therapy due to mechanical heart valves.

Mechanical valves require lifelong anticoagulation to prevent clot formation on the valve, which can lead to serious complications such as stroke. However, during the time leading up to and following an endoscopic procedure, maintaining optimal anticoagulation is crucial. Therefore, anticoagulation therapy is typically paused temporarily.

Bridging with heparin (often low molecular weight heparin) allows for the patient to maintain some level of anticoagulation while ensuring that the risk of bleeding during the procedure is minimized. This approach strikes a balance between preventing thromboembolic events associated with discontinuing anticoagulation and avoiding excessive bleeding that can occur if anticoagulation is continued without modification.

Continuing anticoagulation without changes poses an increased bleeding risk during the endoscopic procedure, which can complicate the procedure and increase recovery time. Discontinuing anticoagulation without further action would leave the patient unprotected from thromboembolic events while also increasing the risk