How Long to Stop Eliquis Before Endoscopy
For high-risk endoscopic procedures (polypectomy, EMR, ESD, sphincterotomy), stop Eliquis 3 days (72 hours) before the procedure if renal function is normal. 1
Risk Stratification of Endoscopic Procedures
The first critical step is determining whether your endoscopy is low-risk or high-risk for bleeding:
Low-Risk Procedures
- Diagnostic endoscopy with or without biopsies 1
- Biliary or pancreatic stenting without sphincterotomy 1
- EUS without sampling or interventional therapy 1
High-Risk Procedures
- Polypectomy 1
- ERCP with sphincterotomy 1
- EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) 1
- Endoscopic dilation of strictures 1
- PEG (percutaneous endoscopic gastrostomy) placement 1
- EUS with fine needle aspiration or interventional therapy 1
- Treatment of varices 1
Discontinuation Protocol
For Low-Risk Procedures
Simply omit the morning dose of Eliquis on the day of the procedure. 1, 2, 3 No extended discontinuation period is needed, and bridging anticoagulation is not required. 1
For High-Risk Procedures with Normal Renal Function
Stop Eliquis 3 days (72 hours) before the procedure. 1, 2 This updated recommendation from the 2021 BSG/ESGE guidelines supersedes the older 48-hour recommendation from 2016. 1
For High-Risk Procedures with Impaired Renal Function
If creatinine clearance (CrCl) or eGFR is 30-50 mL/min, stop Eliquis 5 days (120 hours) before the procedure. 1, 2 This extended period accounts for reduced drug clearance in renal impairment.
For Rapidly Deteriorating Renal Function
Consult a hematologist immediately to determine the appropriate discontinuation timing and assess whether additional interventions are needed. 1
FDA-Approved Guidance
The FDA label for apixaban states: "Apixaban tablets should be discontinued at least 48 hours prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding." 4 However, the more recent 2021 guideline recommendation of 3 days for high-risk endoscopic procedures represents current best practice based on accumulated clinical experience. 1
Resumption Protocol
Resume Eliquis 24-72 hours after the procedure once adequate hemostasis has been achieved. 1, 2 The specific timing within this window depends on:
- Bleeding risk of the procedure performed - higher risk procedures warrant waiting closer to 72 hours 1
- Adequacy of hemostasis achieved - if hemostasis is uncertain, delay resumption 1
- Thrombotic risk of the patient - higher thrombotic risk may favor earlier resumption (closer to 24 hours) 1
The FDA label confirms: "Apixaban tablets should be restarted after the surgical or other procedures as soon as adequate hemostasis has been established." 4
Critical Pitfalls to Avoid
Do not account only for the 48-hour recommendation from older guidelines or the FDA label - the 2021 BSG/ESGE guideline specifically updated this to 3 days for high-risk procedures based on accumulated evidence. 1
Do not fail to assess renal function before determining discontinuation timing - patients with CrCl 30-50 mL/min require 5 days off Eliquis, not 3 days. 1, 2 Failure to extend the discontinuation period in renal impairment increases bleeding risk significantly.
Do not resume Eliquis too early after polypectomy or other high-risk interventions - premature resumption (before 24 hours) substantially increases post-procedure bleeding risk. 2
Bridging anticoagulation is NOT recommended when discontinuing Eliquis for endoscopy, even in high thrombotic risk patients. 1, 4 The short half-life of DOACs makes bridging unnecessary and potentially harmful.