Discontinue warfarin prior to colonoscopy? No, yes, maybe!

My last colonoscopy 5 years ago was prior to my AF diagnosis , so i was of course not on warfarin as I am now.

All my previous colonoscopies have revealed polyps (though only one on the last occasion) which were excised and biopsied.

I asked the gastroenterologist yesterday if I should discontinue warfarin prior to the procedure I've had scheduled and he thought not -- removal of a few polyps would not, he thought, cause excessive bleeding. Later in the day I phoned the "clinical team" number given in the instructions for the colonoscopy to tell them, as the leaflet said I should do, that I am on warfarin. The person I spoke to said I should discontinue warfarin prior to the colonoscopy otherwise I'd be risking having to have a second colonoscopy for the removal of any polyps found. He advised calling my anticoagulation clinic to see if I should be switched from warfarin to something else prior to the procedure.

The nurse I spoke to there said that that was not something they decided but that I should get advice from "the doctor;" I was confused enough not to remember to ask if that meant the gastroenterologist, the endoscopist, or even my GP.

Before wandering further into this maze I thought I'd ask advice from people on this Forum. I've very much appreciated all the information and encouragement provided by the many messages I've read here for quite some time, so this is also an opportunity to thank all those who've help educate and often comfort me in the past.

17 Replies

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  • I'm not medically trained and I would urge you to get confirmation BUT all the ops and "oscopies" I have had I stopped warfarin five days previously as instructed.

    Bob

  • Hi Bob,

    Many thanks. I suspect, from bits and pieces I've spotted, that you're exactly right.

    Did they have you replace the warfarin with anything?

    jusjay

  • i stopped warfarin before 3 ops had low molecular weight heparin injections pre and post op for 2 procedures and post op for one until INR came back in range. Someone needs to give you accurate information.

  • Is the gastroenterologist, who told you to continue taking warfarin, the same person who will be carrying out the colonoscopy? If it is, then I don't see a problem. Keep taking the tablets!

  • Had a colonoscopy three years ago when I was on warfarin (recently changed to Riveroxaban). I was advised by to cease taking warfarin by the person carrying out the colonoscopy four days before the procedure.

  • Depends on the reason for taking Warfarin. I have an artificial heart valve so yes, I have to come off Warfarin before an op/procedure, but I nearly always require Fragmin (Heparin) injections for a few days, then back on Warfarin. I recently had a reveal device fitted. My pre op instructions simply said to stop Warfarin 5 days before, with no mention of Fragmin, When I challenged this, my Cardiologist stepped in and changed the instruction. When in doubt, check it out. Good luck

  • Thanks Anticoag Now, credimus, and lindylou 72. It was the gasstroenterologist who thought I could stay on warfarin, but the endoscopy team who said not to (and the colonoscopy will be done by an endoscopist). Lindylou, I'm on warfarin because of long term (3 years since diagnosed) AF (PAF?). I'll try the endoscopy "clinical team" .this coming week. They may not have been at their best late on a Friday! And also try to talk to a nurse at the anticoag clinic.

    jusjay

  • Left out frills in my last post. Sorry, and thank you too.

    j

  • Hi jusjay9, I had a colonoscopy this year and my appointment letter told me to stop taking Warfarin 5 days prior to procedure. Also had endoscopy a couple of weeks before and the same thing. So, yes, stops taking Warfarin beforehand.

    Hope all goes well.

    Di

  • Have you asked your cardiologist about this? A friend's husband was off it for 5 or 6 days beforehand but since afterwards he developed severe bleeding, he was told to be off for longer the next time.

    Heather

  • Thanks Di and Heather.

    I am seeing an EP (for the first time) in a couple of weeks and will ask his advice. Haven't seen a cardiology consultant at any point, just registrars and other doctors in cardiology, so don't havea particular person to contact.

    Looks to me from kind advice here and other stuff I've been reading that it is highly probable I'll go off warfarin about 5 days in advance and (I think) be put on something else for a while.

    I'll write again when I know about going off warfarin and what I'll be taking instead.

  • Today's saga - or is it a sitcom ("Carry On Colonoscopy")?

    Again phoned the number in the Colonoscopy leaflet (Hospital A) and told that I should get advice from the anticoagulation clinic that sends me my INRs, advises on dose, etc.

    Spoke to the anticoag team at Hospital B and told that I should get advice from Hospital A, not them. When I explained that Hospital A told me that it was up to them (B) they said I should get A to call them.

    Called A who said he's "try to speak to B." Said he didn't need any of my medical record numbers.

    A called me, said B were "rude" and unhelpful; advised me to discontinue warfarin 5 days before the colonoscopy and get my GP to put me on heparin at that time. Said they (Hospital A) would also like an INR taken as close to the time of the colonoscopy as possible; explained my appointment was for 9:30 on a Monday so Friday would be the earliest possible; told that would be ok, or even a week ahead (!).

    B called me, said A had my name wrong and no medical record numbers but they'd belatedly figured out he was calling about me. Told them he'd told me what was needed and I'd see my GP asap, and they gave me an appointment for a blood draw on the Friday before the procedure.

    Now can go through the usual "catch the doctor if you can" process with my GP's office and, with luck, get things in place for the switch.

    You have to give the NHS credit for employing innovative methods to keep one too busy to worry about one's medical problems!

    jusjay

  • Hi Jusjay

    I used to be an endoscopy nurse, I changed direction about 10 years ago so things might have changed, but we used to stop anti coag's 3 days prior to procedures. I was n't aware of any alternatives being prescribed such as Heparin, but all hospitals will work a little differently. Hope you get your answers soon. Regards Chris.

  • Hi Fussyface,

    Many thanks. Got the same advice you gave from both my experienced GP and the EP I saw --stop Warfarin three days before and don't take alternatives like Heparin; resume Warfarin the evening of the day one has the procedure unless there's extensive excision of polyps and lots of bleeding.

    jusjay

  • Hi jusjay

    My colonoscopy appointments came with instructions to stop the Warfarin beforehand too. I’m not on Warfarin myself, but I’ve had a similar story of ineptitude, so I would warn against assuming that the right hand knows what the left is doing.

    I was taken to A&E and diagnosed with AF in August 2012, shortly before I had my first colonoscopy. When the appointment came through, I noticed that the side effects of the Picolax included heart arrhythmia, so I decided to query if it was safe for me to take:

    “Oh it’ll be OK……….er, hang on a minute I’ll check with the doctor……………no, you mustn’t take it”

    Instead, I was told to turn up early and they would do an enema instead. Come the day, I sat in the waiting room until the original appointment time and then got called.

    “You do realise I haven’t had the laxative, don’t you?”

    “No”

    So they did the enema, I had a sigmoidoscopy, and they found a growth which was too large to remove with the endoscope. They handed me a report that said the exam hadn’t been completed due to “poor bowel prep” and told me they’d have to arrange another appointment for a full colonoscopy.

    A few days later I got another appointment just like the first, so I rang and asked what alternative arrangements were being made.

    “What alternative arrangements?”

    Eventually I was told that the community hospital can’t do the job and I would have to go to the back of the waiting list for an appointment at the general hospital. When I arrived, I was told that my heart had no implications whatsoever for the colonoscopy, and that I had been referred because the community hospital doesn’t have an endoscope facility. When I said that I didn’t understand why the contradiction, she just repeated herself in a slower, louder voice. I pressed the matter further:

    “If you won’t believe me I’ll show you the referral letter!”

    “Yes, please.”

    “No, you’re not allowed to see it.”

    I don’t know what her name was, Dr Kafka perhaps. When I asked her how I could already have been for an appointment if they don’t have a facility, she just told me if I have another appointment I need to cancel it. At that point I just gave up banging my head against the wall, and went with the flow.

    Two months later some light was shed when I saw the cardiologist, and he flatly denied that I had ever been to A&E and diagnosed with AF:

    “There’s no record that it ever happened, there’s nothing wrong with you, you’re discharged.”

    No wonder my heart didn’t have any implications for the colonoscopy!! Next time I saw the bowel doctor I took some proof: copies of the paramedics worksheet, an ECG, and the letter from A&E to my GP.

    “Alright, alright, it’s not a problem, there’s nothing to get worried about.”

    As per usual it’s none of their fault, I’m just a “neurotic who can’t cope with conflicting information” so I’ve been told. The appointments with the general hospital came with Moviprep laxative instead of Picolax, which has no mention of arrhythmia on the side effects. Whether that’s by accident or design I wouldn’t know.

  • Hi ectopic 1,

    Wow, what a saga! Makes the Kafkaesque efforts of my GP practice look quite amateurish. Far better than any other episodes of my "Carry On Colonoscopy" sitcom and good enough to start a new series modelled on that great monument to lunatic bureaucracy "Yes, Prime Minister."

    I put Picolax into my medication list on Mediguard.org (a site I've mentioned before and where I check on drug interactions) and it set off no alarms in relation to Warfarin or any other drugs in my fairly extensive list. The package insert that came with the Picolax does not have AF in its "Do not take Picolax if..." list.

    jusjay

  • That's not the half of it, after they denied I had been to A&E I ended up back again. While I was laid in bed with a HR of 230 they said it was just a faulty monitor, and told the nurses to "take no notice of anything he says". Later I was told me that they'd "never seen an abnormal ECG" after they had printed at least nine to my knowledge. Then I was told that my HR can't have been over 200 or I would have been unconscious. (Have a look at my avatar, it's 216, and I was sat in the armchair chatting with the paramedic as it was being printed!) When I was back again this week they told me I was in NSR not AF, and sent me home with a HR of 130. A few hours later I had to call another ambulance when my HR went up to 220. The paramedic told me that I had Atrial Flutter, not AF or NSR, but by the time I got back to A&E the doctor was talking to me like a neurotic and try to persuade me that I wasn't having a heart attack. At that point there was still another two doctors and twelve hours to wait before I had a cardioversion.

    It's what you get for making a complaint against the NHS, they ignore the complaint and up the ante. If I complain further I get told "If you don't like it, go elsewhere".

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