Hi all,
I’ve had colitis for thirty years and have had a surveillance colonoscopy at five yearly intervals. I was recently diagnosed with AF and am now absolutely terrified of having a colonoscopy in case I go into AF while having the procedure. I also feel very anxious about stopping Apixaban for three days beforehand. Basically my deepest fear is that such an invasive procedure might trigger a stroke.
I would appreciate any thoughts and comments.
Thanks,
Merrylass
I have had a number of colonoscopies over the past ten years and on anticoagulation for afib stroke risk, the last colonoscopy being six months ago.
I have not had any issues with afib being triggered by the procedure or lack of anticoagulant. What I would emphasise is the need to drink copious amounts of liquid during the bowel prep as dehydration is a trigger for afib and we loose lots of water during the bowel prep phase.
Medics seem to give various advice about when to stop anticoagulation before the procedure. I was told to stop just 24 Hours in advance but some say two or three days. Best wishes, you will be fine.
I have atrial fibrillation / flutter, I've had a stroke, sigmoidoscopies, colonoscopies, and I take Pradaxa (dabigatran). I've been told to stop Pradaxa the day before the colonoscopy and re-start the day after. I check that the sedation needle is taped on, as rolling onto my side has caused the needle to drop out. I was advised by a nurse to say that I didn't want a trainee to carry out the colonoscopy, as it's a teaching hospital.
I’ve also had UC for many years and have Afib, a pacemaker and on Apixaban which I stopped for 4 days last colonoscopy, everything was fine. Even if you did have an issue while having it done you are at least in the right place ! Good luck and try not to stress over it.
They are used to this. Just make sure that both the gastroenterologist and ep are onboard regarding the anticoagulation hold. I never went into afib, during my colonoscopies, but if you should, they will be prepared to handle it. That said, I told them that if I went into afib, I had Flecainide with me to convert and would like to take the pill myself after they were finished. It's a very short procedure and they agreed.
Jim
Hi
I am on apixaban and had a colonoscopy in the autumn. I stopped taking it 3 days before. The issue I had was that I started again immediately leading to some bleeding. I should have left it a couple of days before starting again.
hi,
We’re you not advised when to restart taking the Apixaban?
Thanks.
Hi I’ve had AF since 2017 and had 2 ablations and a minor op under GA during that time . Last year I had a colonoscopy under mild sedation and went into AF as I was travelling to the hospital for the procedure. It didn’t cause any issues at all and I told myself not to worry any more than I already was about having the procedure as it was necessary to protect my future health .
I too have had a colonoscopy since Afib & on anticoagulation. I stopped taking the Apixaban as directed. The colonoscopy did not trigger my Afib. Please remember you will be given sedation. I would let them know you feel anxious (not uncommon) & am sure they will help you to manage your anxiety.I had no problems too. No Afib triggered. Can't remember when I restarted the anticoag.
many thanks for taking the time to reply. In fact I was so anxious that I cancelled the colonoscopy. However, having heard from so many of you now about your experiences I will probably make another appointment in the near future.
Merrylass
While in permanent AF I've had 3 colonoscopies and one sigmoidoscopy. One year I had 2 colonoscopies close together, the first diagnostic while still on Warfarin, the second to remove the 4 polyps found, after I'd stopped Warfarin. This year I had one colonoscopy while not on Warfarin and nothing was found. The team undertaking the colonoscopies knew of my permanent, though asymptomatic AF. I didn't have sedation as I live alone, and only used gas and air once or twice.No polyps were found during my colonoscopy this year, so I am unlikely to need another. None of them affected my AF.
My afib was triggered by the bowel prep so I was actually in afib when I had my colonoscopy (this was a CT colonoscopy though). I was still in afib 24 hours later. Did t stop apixaban and wasn't asked to.
Thanks for your comments.
I had a colonoscopy a few days ago. I also take apixaban and was told to not to take the previous 5mg pill before the procedure. Apixaban has a short half life, so I guess the exposure is short.
Also Afib can be triggered by dehydration so drink lots of water during the bowel prep
I know how important hydration is for the heart . Many thanks
I think anxiety is probably a bigger trigger than the actual procedure. Make sure you insist on being given sedation and pain relief before they start. They can’t refuse to give it to you.
I had a large stage 2 polyp removed and bleeding wasn’t an issue at all, despite having stopped my Apixiban 24 hours before.
I think you’ve spot on about the anxiety being the biggest trigger. I realised I was so overwhelmed by anxiety that there was no way I could go ahead with the procedure as my whole nervous system felt under seige. I now feel a whole lot calmer about it now having read all of your supportive comments.
Many thanks. Merrylass
Hi
If your heart rate is under 100 better @ 90bpm, your AF is controlled.
I had to stop 3 clear days for partial removal of TVT Johnson sling with mesh. I stopped 3 days the other side. It is a 'bloody' and messy operation. No problems.
I had an extra Dr in there. So it was done in the public instead of private because
Make sure you walk before and after operation. If I remember I was out of hospital same day and shortly after discharged. The meds for an empty colon and bowel was quite 'important'.
I had that and stomach another time and then scan of gall bladder. Small balls were seen and I was told shouldn't give me the episodes I was having.
Then I found out grandfather had his out. So an operaio scheduled.
Surgeon came by next day. Bits of gall Bladder removed it had completely disintegrated! I had acid stomach from aged 4 years! Mum fed me Milk of Magnesia.
You know your body better than any Dr or Specialist.
Best wishes.
I take Colofac 140mg for constipation. Full glass of water 1 hour before breakfast. Before lunch and tea but it always works before breakfast. ( It simply relaxes colon and bowel)
cheers JOY. 74 (NZ)
Thank you very much for sharing your lovely experiences. All the best to you.
Merrylass
I have paroxysmal AF and had a colonoscopy in December. I had been told to stop Edoxaban 36 hours before the procedure which I did. When I met the gastro doc at the hospital he said he would do the colonoscopy examination but if I needed anything removed eg a polyp I would have to come back as I hadn’t been off the Edoxaban for long enough and there was too great a risk of bleeding. So as with all things AF it’s a balance. If I were you I would go with the advice and stay as relaxed as possible. I was absolutely fine - no problems with prep or procedure. Just drink plenty of water and relax as much as possible. You will be fine!
Thank you so much. Merrylass
I stopped anticoagulants for three days prior to colonoscopy recently. No issues at all. Just follow all instructions to the letter and you’ll be fine.
I've had 2 colonoscopy. On one I was actually in AF at the time and the other I wasnt in AF and it dudnt bring on an attack. On both occasions I had to stop apixaban beforehand but had no complications with either.
I have recently had similar fears and nearly two weeks of worry, but all is well.
Yesterday, I resumed apixaban after nearly two weeks without it, stopping three days before a sigmoidoscopy and polypectomy and not starting, owing to slight blood loss, until well over a week afterwards It was a safe polyp but one that was so near the surface as to be difficult to remove - ouch, ouch, ouch! I can share your fears but I'm still here to tell the tale. Luckily my heart was fine for the duration although the last three days it was dancing around but without AF. During the procedure, it was fine, not even speeding up too much. I took bisoprolol throughout just in case, following my GP's advice.
The theatre nurse told me that he had never, in fifteen years of doing his job, had a problem with an AF patient and he had had lots. The only issue he'd had at all was with a man who suffered pulmonary embolisms for some other reason.
Could you do as I did and take an extra dose of your beta blocker or whatever, say - with your GP's approval?
Hello, Merrylass... I, too, have had those concerns, but I've had ulcerative colitis for 40+ yrs since very young, have paroxysmal afib, and have never had any problems during a colonoscopy or flex sig. The sedation they will give you calms everything down. If your last few colonoscopies have been clear, you may be able to delay this one for awhile. From what my GI dr. said, it is rather rare for people to go into afib during a colonoscopy. Blessings & prayers for a calm procedure, Diane S.
Thank you so very much for your kind words and support.
Merrylass
You're welcome! and, Merrylass, one other tip. I used Miralax last time (available at grocery stores here in the US--not sure where you are) and it was by far the gentlest, best prep experience I ever had... and I've had every type imaginable! But w/ Miralax I hardly realized it was a prep, and the dr. said I was very clear & easy to view, so it worked well, too. But the best thing was that it didn't upset the heart in any way.
If you go into afib while you are off the Apixaban and having the colonoscopy they might give you an injection of Lovenox . I have to have a five year check up colonoscopy soon. I am not worried about it . The prep my gastroenterologist prescribes has large amounts of some sort of magnesium in it. I have had 2 colonoscopies since starting with afib and the prep for the second one was awful as it was after my colectomy . No afib prepping or during but I did have an episode a week later.
many thanks.
Had no issues with several colonoscopies previously, only the prep part which I hate. I have had Crohn's Disease since 1985
I had a general anaesthetic in august last year and had to stop my anti coagulant 3 days before and I was fine afterwards. I had extra anaesthetists in theatre just in case. They wouldn’t do the procedure if they thought you were high risk.
Welcome to the forum, Merrylass!
You were concerned " in case I go into AF while having the procedure. I also feel very anxious about stopping Apixaban for three days beforehand. Basically my deepest fear is that such an invasive procedure might trigger a stroke."
The connection between atrial fibrillation and strokes relates to the possibility that, while in AF, a small stagnant pool of blood may develop in the atria that could form a blood clot. However this process takes a considerable time and does not occur suddenly when you experience AF. It's a cumulative process. So a short period of AF during your procedure is unlikely to trigger a stroke, whether you are taking an anticoagulant or not.
The anticoagulant is more for long-term protection against a clot forming.
I have permanent AF (although symptom free) and had to stop using the anticoagulant fir several months until a non-heart issue was resolved, but I was never concerned about short term stroke risk. I'm back on the anticoagulant now though!
Best wishes,
Paul
Thank you Paul for your very helpful comments about blood clot formation.
Merrylass
I'm on apixaban also and I had my cardiologist involved in planning my colonoscopy. He said he didn't see any problem with stopping Med for 48 hours and I had no issues or afib during prep or the procedure itself.Like meadfoot said, stay hydrated. Set a timer and drink regularly while you prep. You will be fine!
I needed an investigation after the national bell screening test picked up blood in my sample. Instead of a colonoscopy they did an abdominal CT scan instead. That ruled out need for a more invasive procedure.
yes in Scotland.
can I be cheeky and ask how you got away without a colonoscopy?
Friends who tell me they had blood in their stools were routinely offered a colonoscopy.
Thanks. Merrylass
I had breast cancer surgery two years ago so the stool test was a worry. There is a waiting list for colonoscopy so I was sent for the CT scan first. I was told it would show if there was anything to worry about and a colonoscopy would be done if so. It’s not so much blood clots but excessive bleeding can be triggered so I would need to stop the Apixaban for a few days. As it was I got scanned and given the all clear a week after sending the test in.
For the cancer surgery I had review by cardiology and my heart rate meds increased a few weeks ahead of surgery. Stopped Apixaban two days before. My heart behaved itself throughout!
I am so glad I came upon this post. Same issue here, scheduled for colonoscopy next week and scared to death that an episode of AF might happen while I am not on Eliquis 
Had not had an episode since January and then had one last week which lasted for about 6hrs but heart rate 70-90
hi,
I’m scheduled for a colonoscopy in two weeks time. I have Af pretty regularly now, at least once a week. I’ve stopped stressing about stopping the blood thinners. If I have AF during the colonoscopy I’m sure the hospital have experience with this. I found the stress of worrying about being off the blood thinners was debilitating. So I’ve now got a much calmer attitude and hope that all will be well. Sending you best wishes and a graceful experience. Merrylass
Update on colonoscopy 
Colonoscopy
Colonoscopy 
colonoscopy and A fib
Discontinue warfarin prior to colonoscopy? No, yes, maybe!
