When to stop taking Eliquis (apixaban) before a colonoscopy?

From the Guidelines

If you're taking Eliquis (apixaban) and scheduled for a colonoscopy, you should typically stop taking it 48 hours before the procedure, as recommended by the most recent guidelines 1. For patients with normal kidney function, this 2-day window allows the medication to clear from your system sufficiently to reduce bleeding risk during the colonoscopy. The decision to stop Eliquis should be made in consultation with the doctor who prescribed it and the doctor performing the colonoscopy, as individual circumstances may require different timing. Key factors to consider include the type of procedure being performed during the colonoscopy, such as polyp removal, and the patient's individual bleeding risk. After the colonoscopy, Eliquis can usually be resumed 24-48 hours later, depending on the specifics of the procedure and the patient's condition. It's also important to note that for patients with reduced kidney function, the doctor might recommend stopping Eliquis 3 days before the procedure, as the drug's clearance is affected by renal function 1. Eliquis works by inhibiting Factor Xa in the clotting cascade, and temporarily discontinuing it allows for normal clotting during invasive procedures like colonoscopy. In some cases, particularly for patients with atrial fibrillation or a history of blood clots, the doctor might recommend temporary bridging therapy with a different anticoagulant during the period when Eliquis is stopped 1. The management strategy for stopping Eliquis before a procedure like colonoscopy should follow a pharmacokinetic-based approach, taking into account the drug's half-life and the patient's renal function 1. This approach ensures that the risk of bleeding is minimized while also considering the risk of thrombotic events. Given the most recent guidelines, stopping Eliquis 48 hours before a colonoscopy is the recommended approach for most patients, with adjustments made based on individual patient factors 1.

From the FDA Drug Label

2.3 Temporary Interruption for Surgery and Other Interventions 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 Apixaban tablets should be discontinued at least 24 hours prior to elective surgery or invasive procedures with a low risk of bleeding or where the bleeding would be non-critical in location and easily controlled.

Stopping Eliquis (apixaban) before colonoscopy:

• The recommended duration to stop apixaban before a procedure depends on the bleeding risk associated with the procedure.
• For procedures with a moderate or high risk of bleeding, apixaban should be stopped at least 48 hours before the procedure.
• For procedures with a low risk of bleeding, apixaban should be stopped at least 24 hours before the procedure.
• Since colonoscopy is generally considered a procedure with a low to moderate risk of bleeding, apixaban should be stopped at least 24 to 48 hours before the procedure, depending on the specific circumstances and the clinician's judgment 2.

From the Research

Stopping Eliquis Before Colonoscopy

• The decision to stop Eliquis (apixaban) before a colonoscopy depends on the individual patient's risk of thromboembolism and bleeding 3.
• For patients undergoing colonoscopic polypectomy, the overall risk of postpolypectomy bleeding is less than 0.5% 3.
• The direct oral anticoagulants (DOACs), such as apixaban, have a rapid onset and offset of action, and periprocedural bridging is generally not necessary 3.
• A study found that apixaban patients had a lower risk of recurrent venous thromboembolism and major bleeding compared to low-molecular-weight heparin (LMWH) and warfarin patients 4.

Management of Anticoagulants During Colonoscopy

• The management of anticoagulants during colonoscopy involves weighing the risk of thromboembolism against the risk of bleeding 5, 3.
• For low-risk procedures, such as colonoscopy with biopsy, it is not necessary to adjust anticoagulation 5.
• For high-risk procedures, such as polypectomy, the decision to interrupt or continue anticoagulants will involve considerable exercise of clinical judgment 3.
• A study found that fixed-dose high-risk thromboprophylactic therapy with low-molecular-weight heparin is safe and effective as a bridging therapy in patients undergoing colonoscopy or gastroscopy 6.

Bridging Therapy During Interruption of Oral Anticoagulation

• Bridging therapy with low-molecular-weight heparin may be necessary for patients at high risk of thromboembolism who require interruption of oral anticoagulation for colonoscopy or gastroscopy 6.
• A study found that apixaban is a potential option for cancer patients with venous thromboembolism, with a lower risk of recurrent venous thromboembolism and major bleeding compared to LMWH and warfarin 7, 4.