Endoscopy and Colonoscopy on Anticoagulants: What to Hold and When to Restart

This guide is for clinicians planning elective endoscopy or colonoscopy in patients on anticoagulants. It is a conservative summary. It does not reproduce guideline tables. Confirm local policy.

Start with the procedure plan

Diagnostic endoscopy without intervention has a different bleeding profile than colonoscopy with polypectomy. Clarify what is planned. If there is a chance of polypectomy or EMR, treat it as higher risk when planning holds and restarts.

DOACs

• When to hold: base this on the expected bleeding risk. Extend conservatively for higher risk interventions and for reduced renal function.
• When to restart: after hemostasis is secure. High risk cases restart later than low risk diagnostic work.
• Neuraxial is not typical: but if a neuraxial technique is planned for another reason, follow the stricter neuraxial rules.

Warfarin

• Stop 5 days before the case for most elective plans.
• INR check: target less than 1.5 near the time of the procedure. Correct or delay if 1.5 or higher within 24 to 48 hours.
• Bridging: only for high thrombosis risk. If creatinine clearance is less than 30, prefer UFH for bridging.

Practical examples

• Diagnostic EGD on apixaban: short hold, early restart once hemostasis is clear.
• Colonoscopy with planned polypectomy on rivaroxaban: longer hold and later restart. If bleeding risk changes during the case, adjust the plan conservatively.
• Warfarin with polypectomy: stop 5 days before, confirm INR less than 1.5 pre-procedure, consider bridging only if risk is high.

For patient specific timelines use the AnticoagPlanner calculator. It provides timestamped stop and restart guidance keyed to the booked time.

FAQ

How long to hold Eliquis before colonoscopy

Match the hold to the planned intervention. Treat polypectomy as higher risk and extend conservatively.

Should I bridge for colonoscopy

Bridge only for high thrombosis risk in warfarin patients. Do not bridge DOACs.

When to restart after polypectomy

Restart after adequate hemostasis. Higher risk cases restart later than purely diagnostic work.

Sources

• MD Anderson. Peri-Procedure Anticoagulants, V8 approved 2025.
• Institutional neuraxial catheter timing summaries derived from ASRA guidance.