When should a patient with a history of Deep Vein Thrombosis (DVT) resume taking apixaban (apixaban) after an Esophagogastroduodenoscopy (EGD) or colonoscopy?

When to Resume Apixaban After EGD or Colonoscopy in DVT Patients

Resume apixaban 24 hours after the procedure (the next day) for both EGD and colonoscopy, as these are classified as low-to-moderate bleeding risk procedures. 1, 2, 3

Procedure Bleeding Risk Classification

EGD and colonoscopy without polypectomy or biopsy are considered low bleeding risk procedures. 1 Even with polypectomy or biopsy, these remain in the low-to-moderate bleeding risk category, not high-risk procedures like major abdominal surgery or neurosurgery. 1, 3

Timing of Resumption

Standard Approach (Low-to-Moderate Risk)

• Resume apixaban at your usual dose 24 hours after the procedure (the next day, not the evening of the procedure). 1, 2, 3
• The FDA label specifies that apixaban should be restarted "as soon as adequate hemostasis has been established" after procedures. 4
• The 24-hour window allows sufficient time for procedural hemostasis while minimizing thrombotic risk in DVT patients. 1

High Bleeding Risk Procedures (Not Applicable Here)

• For comparison, high bleeding risk procedures (major surgery, neurosurgery) require waiting 48-72 hours before resuming anticoagulation. 1, 5, 2
• EGD and colonoscopy do not fall into this category. 1

Dosing Considerations

For Active DVT Treatment

• If you are in the first 7 days of DVT treatment, resume apixaban at 10 mg twice daily. 4
• If you are beyond 7 days of DVT treatment, resume apixaban at 5 mg twice daily. 4
• If you are on extended secondary prevention (after completing initial treatment), resume apixaban at 2.5 mg twice daily. 4

No Bridging Required

• Do not use bridging anticoagulation (heparin or LMWH) during the 24-hour interruption period for low-risk procedures. 1, 3
• Bridging is only considered for very high thrombotic risk patients undergoing high bleeding risk surgery, which does not apply to routine endoscopy. 1

Critical Pitfalls to Avoid

• Do not resume the evening of the procedure - waiting until the next day (24 hours) is the standard recommendation to ensure adequate hemostasis. 1, 2
• Do not delay beyond 24 hours for low-risk procedures, as this unnecessarily increases thrombotic risk in DVT patients. 1, 3
• Do not use prophylactic-dose anticoagulation as a bridge - simply resume your full therapeutic dose at 24 hours. 1, 3
• Ensure you take apixaban with food when resuming, as absorption is significantly reduced without food. 5, 4

Special Circumstances

If Significant Bleeding Occurred During Procedure

• If there was unexpected bleeding during the procedure requiring intervention, discuss with your gastroenterologist about potentially extending the interruption to 48 hours. 1
• This is uncommon but represents a situation where individualized timing may be warranted. 1

Renal Function Considerations

• If you have moderate renal impairment (creatinine clearance 30-49 mL/min), the standard 24-hour resumption timing still applies for apixaban. 5, 4
• No dose adjustment is needed for DVT treatment in this renal function range. 5, 4

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