From the Research
Eliquis (apixaban) should typically be held before a screening colonoscopy, with the recommendation to stop taking it 48 hours before the procedure and resume 24-72 hours after, depending on bleeding risk. For patients at standard bleeding risk, resuming 24 hours post-procedure is common, while those at higher bleeding risk may need to wait 48-72 hours. This temporary discontinuation is necessary because apixaban is an anticoagulant that inhibits factor Xa, reducing blood's ability to clot. During colonoscopies, especially if polyp removal (polypectomy) is performed, there is a risk of bleeding that could be exacerbated by anticoagulants. However, this recommendation must be individualized based on the patient's specific thrombotic risk. Patients with mechanical heart valves, recent venous thromboembolism, or atrial fibrillation with high CHADS2 scores may need bridging therapy with shorter-acting anticoagulants or modified discontinuation schedules. Always consult with both your prescribing physician and gastroenterologist before stopping Eliquis, as they will provide personalized guidance based on your specific medical history and risk factors, as supported by the most recent study 1. Some key points to consider include:
- The risk of post-polypectomy bleeding is lower with apixaban compared to warfarin, dabigatran, and rivaroxaban, as shown in a population-based analysis 1.
- The decision to interrupt or continue anticoagulants for endoscopy involves considerable exercise of clinical judgment, taking into account the patient's individual risk factors and medical history 2.
- Resuming anticoagulation or antiplatelet agents post-polypectomy can be safe and does not significantly affect the post-polypectomy rate of hemorrhage, as found in a retrospective review of patients undergoing colonoscopy with polypectomy while on anticoagulation therapy 3. It is essential to weigh the risks of precipitating thromboembolic complications if anticoagulants are stopped against the risk of postpolypectomy bleeding if these agents are continued, and to make an informed decision based on the most recent and highest-quality evidence available 1.