From the Guidelines
DVT prophylaxis typically does not need to be held prior to upper endoscopy or colonoscopy for most patients. For patients on pharmacological prophylaxis with subcutaneous heparin, low molecular weight heparin (such as enoxaparin), or low-dose unfractionated heparin, these medications can generally be continued without interruption as they carry a low bleeding risk during standard diagnostic endoscopic procedures 1. However, for patients on therapeutic anticoagulation, management should be individualized based on bleeding risk of the procedure and the patient's thrombotic risk.
Key Considerations
- If biopsies or therapeutic interventions are planned during the endoscopy, temporary interruption of anticoagulation might be considered.
- For standard diagnostic procedures without biopsies, even therapeutic anticoagulation can often be continued.
- The decision should balance the risk of thromboembolism if anticoagulation is interrupted against the risk of bleeding during the procedure.
- For high bleeding risk procedures like polypectomy of large polyps, consider holding the morning dose of prophylactic anticoagulants on the day of the procedure and resuming afterward 1.
Procedure-Specific Guidance
- High-risk endoscopic procedures in patients at low thrombotic risk: discontinue P2Y12 receptor antagonists 7 days before the procedure and warfarin for 5 days before the procedure, with INR check prior to the procedure to ensure <1.5 1.
- High-risk endoscopic procedures in patients at high thrombotic risk: continue aspirin and consider liaison with a consultant interventional cardiologist about the risk/benefit of discontinuing P2Y12 receptor antagonists, and temporarily discontinue warfarin and substitute with low molecular weight heparin (LMWH) 1.
From the Research
DVT Prophylaxis and Endoscopy/Colonoscopy
- There is no direct evidence in the provided studies to suggest that DVT prophylaxis needs to be held prior to upper endoscopy and colonoscopy 2, 3, 4, 5, 6.
- The studies primarily focus on the comparison of enoxaparin and unfractionated heparin for VTE prophylaxis in various patient populations, including medically ill patients and those in intensive care units 2, 3, 6.
- One study discusses the treatment of DVT and the duration of anticoagulant treatment, but does not address the specific context of endoscopy or colonoscopy 4.
- Another study compares the efficacy and safety of once-daily enoxaparin in the outpatient setting with unfractionated heparin in hospital for the treatment of symptomatic deep-vein thrombosis, but does not mention endoscopy or colonoscopy 5.
- Overall, there is a lack of research directly addressing the question of whether DVT prophylaxis should be held prior to upper endoscopy and colonoscopy.