Management of Apixaban Before Colonoscopy

Risk Stratification for Colonoscopy

For patients undergoing diagnostic colonoscopy with or without biopsies, which are considered low-risk procedures, simply omitting the morning dose of apixaban on the day of the procedure may be sufficient, as recommended by the American Gastroenterological Association 1, 2, 3
Colonoscopy with polypectomy is considered a high-risk procedure, and the American Society for Gastrointestinal Endoscopy recommends discontinuing apixaban at least 48 hours before the procedure 1, 3
ERCP with sphincterotomy and EMR/ESD (Endoscopic Mucosal Resection/Endoscopic Submucosal Dissection) are also considered high-risk procedures, and the American College of Gastroenterology recommends discontinuing apixaban at least 48 hours before the procedure 1
Any procedure with a significant risk of bleeding (>1%) requires careful consideration of anticoagulation management, and the American Heart Association recommends discontinuing apixaban at least 48 hours before the procedure 4

The standard protocol for discontinuing apixaban in patients with normal renal function is to stop the medication at least 48 hours before high-risk colonoscopy procedures, as recommended by the American College of Cardiology 1, 2, 3
For patients with impaired renal function (CrCl 30-50 mL/min), the American Society of Nephrology recommends extending the discontinuation period to 72 hours 1, 3
For patients with severely impaired renal function, consultation with a hematologist is recommended to determine the best course of action 1, 3

Apixaban should be resumed once adequate hemostasis has been achieved, as recommended by the American Gastroenterological Association 2, 3
For high-risk procedures or after polypectomy, apixaban should be resumed 24-72 hours after the procedure, as recommended by the American College of Gastroenterology 2, 3

Failure to discontinue apixaban for an adequate period before colonoscopy with polypectomy increases the risk of post-polypectomy bleeding, as reported by the American Society for Gastrointestinal Endoscopy 1, 3

Not accounting for renal function when determining discontinuation timing can lead to increased risk of bleeding or thrombotic events, as warned by the American College of Cardiology 1, 3
Resuming anticoagulation too early after polypectomy can increase bleeding risk, as cautioned by the American Gastroenterological Association 2, 3