Medication Management for Colonoscopy

Risk Stratification

For patients undergoing diagnostic colonoscopy with or without biopsy, which is considered a low-risk procedure, most medications can be continued 3, 4
Polypectomy is considered a high-risk procedure that may require medication adjustment 1
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are also high-risk procedures that may require medication adjustment 2, 3

The American College of Gastroenterology recommends continuing aspirin therapy without interruption for low-risk procedures 2, 4
For high-risk procedures, aspirin should be continued even if the patient is at high risk of bleeding 1, 2
P2Y12 receptor antagonists, such as clopidogrel, should be discontinued 7 days before high-risk procedures in patients with low thrombotic risk 2, 5
For patients with high thrombotic risk, P2Y12 receptor antagonists should not be discontinued without consulting an interventional cardiologist 2, 5
Warfarin should be continued for low-risk procedures, but discontinued 5 days before high-risk procedures in patients with low thrombotic risk 3, 6
For patients with high thrombotic risk, warfarin should be temporarily discontinued and substituted with low molecular weight heparin (LMWH) 3, 6
Direct oral anticoagulants (DOACs) should be omitted on the morning of the procedure for low-risk procedures, and the last dose should be taken 3 days before the procedure for high-risk procedures 2, 3

Antiplatelet or anticoagulant therapy should be resumed 1-2 days after the procedure if no bleeding complications occur 2, 5
For high thrombotic risk patients, therapy should be restarted as soon as hemostasis is achieved 2
Patients on antiplatelets or anticoagulants should be advised of the increased risk of post-procedure bleeding 2, 6