Washout Periods for Eliquis and Plavix Before Endoscopy
For Eliquis (apixaban), stop 48 hours before high-risk endoscopic procedures and 24 hours before low-risk procedures; for Plavix (clopidogrel), stop 5 days before high-risk procedures while continuing aspirin if on dual antiplatelet therapy. 1, 2
Eliquis (Apixaban) Management
Low-Risk Endoscopic Procedures
- Omit only the morning dose on the day of the procedure (approximately 24 hours from last dose) 1
- Low-risk procedures include diagnostic endoscopy with biopsies, biliary/pancreatic stenting, and device-assisted enteroscopy without polypectomy 3
High-Risk Endoscopic Procedures
- Stop Eliquis 3 days (72 hours) before the procedure 1, 4
- High-risk procedures include polypectomy, ERCP with sphincterotomy, EMR/ESD, variceal therapy, PEG placement, and stricture dilation 3
- The timing remains consistent regardless of renal function as long as creatinine clearance is >30 mL/min, since apixaban has less renal elimination than dabigatran 4
Special Renal Considerations
- For patients with CrCl 30-50 mL/min, the standard 3-day washout still applies for apixaban (unlike dabigatran which requires 5 days) 1, 4
- If renal function is rapidly deteriorating, consult hematology before proceeding 3, 1
Plavix (Clopidogrel) Management
High-Risk Endoscopic Procedures
- Stop clopidogrel 5 days before the procedure 2, 3, 5
- This 5-day washout allows for adequate dissipation of the irreversible antiplatelet effect 5
Dual Antiplatelet Therapy (DAPT) Considerations
- Continue aspirin while stopping clopidogrel 5 days before high-risk procedures 2, 3
- Never stop both antiplatelet agents simultaneously, as this dramatically increases thrombotic risk 2
- For patients with coronary stents placed within 6-12 weeks, liaise with cardiology about the risk/benefit of stopping clopidogrel versus continuing both agents 3
Low-Risk Endoscopic Procedures
- Do not discontinue clopidogrel for low-risk procedures 2, 3
- Mucosal biopsies can be safely performed while continuing antiplatelet therapy 2
Resumption After Endoscopy
Eliquis Resumption
- Resume within 24-48 hours after the procedure once adequate hemostasis is achieved 1, 4
- For low bleeding risk procedures, can resume as early as 6 hours post-procedure 4
- For high bleeding risk procedures, delay 24-48 hours until hemostasis is secure 1
Plavix Resumption
- Resume clopidogrel within 24 hours after the procedure once adequate hemostasis is achieved 5, 2
- Earlier resumption (within 24 hours) is preferred over delayed resumption to minimize thrombotic risk 5
Critical Pitfalls to Avoid
- Never use bridging anticoagulation with heparin or LMWH when stopping Eliquis, as this increases bleeding risk without reducing thrombotic risk 4, 6
- Do not stop both antiplatelet agents in patients on DAPT—continue aspirin while holding clopidogrel 2
- Do not perform high-risk procedures if INR >1.5 in patients transitioning from warfarin 3, 1
- Avoid stopping clopidogrel in patients with recent coronary stents (<6-12 weeks) without cardiology consultation, as stent thrombosis risk is prohibitive 3
Risk Stratification Framework
High Thrombotic Risk Patients (Require Cardiology Consultation)
- Drug-eluting stents within 12 months 3
- Bare metal stents within 1 month 3
- Recent acute coronary syndrome (<3 months) 3
- Prosthetic metal heart valve in mitral position 3