Management of Apixaban Before EGD

Risk Stratification and Discontinuation Protocol

For high-risk endoscopic procedures like EGD, apixaban should be discontinued 3 days before the procedure in patients with normal renal function, as recommended by guidelines from the American Gastroenterological Association 1, 2
EGD procedures are classified based on bleeding risk, with low-risk procedures including diagnostic EGD with or without biopsies, and high-risk procedures including EGD with interventions, according to the American Society for Gastrointestinal Endoscopy 2
For low-risk EGD, simply omit the morning dose of apixaban on the day of the procedure, with no need for bridging anticoagulation, as suggested by the American Society of Anesthesiologists 1, 2, 3
For high-risk EGD with normal renal function, stop apixaban 3 days before the procedure, while for impaired renal function, stop apixaban 5 days before the procedure, as recommended by the American College of Cardiology 1, 3, 4

For patients at high thrombotic risk, consultation with a cardiologist or hematologist is recommended to assess the need for bridging therapy, according to the American Heart Association 2
For high-risk procedures, typically resume apixaban 24-72 hours after the procedure, while for low-risk procedures, apixaban can usually be resumed the same day, as suggested by the American Gastroenterological Association 1, 2

No routine laboratory monitoring is required before the procedure, but check for signs of bleeding after resuming apixaban, and closely monitor patients with high thrombotic risk for thrombotic events during the interruption period, as recommended by the American Society for Gastrointestinal Endoscopy 2, 3