Medication Management for Colonoscopy

Risk Stratification

The American College of Cardiology recommends that patients undergoing low-risk procedures, such as diagnostic colonoscopy with or without biopsy, can continue antithrombotics 1, 3
The American College of Cardiology recommends that patients undergoing high-risk procedures, such as polypectomy, may require medication adjustment 1, 3
Patients with low thrombotic risk, such as those with atrial fibrillation without valvular disease, can continue antithrombotics 1
Patients with high thrombotic risk, such as those with prosthetic metal heart valve, require careful management of anticoagulants 1

The American College of Cardiology recommends that patients on aspirin therapy can continue without interruption for low-risk procedures 1
The American College of Cardiology recommends that patients on P2Y12 receptor antagonists, such as clopidogrel, discontinue 5 days before high-risk procedures for low thrombotic risk patients 1, 4
The American College of Cardiology recommends that patients on warfarin therapy check INR during the week before endoscopy and continue usual daily dose for low-risk procedures 1
The American College of Cardiology recommends that patients on direct oral anticoagulants (DOACs) omit the morning dose on the day of procedure for low-risk procedures 1

The American College of Gastroenterology recommends that cold snare technique is preferred over hot snare for patients on continued anticoagulation requiring polypectomy 2, 6
The American College of Gastroenterology recommends that all patients on anticoagulants should be advised of increased risk of post-procedure bleeding compared to non-anticoagulated patients 1
The American College of Gastroenterology recommends that patients should be monitored for signs of delayed bleeding, which can occur up to 30 days after polypectomy 5