I have just had a telephone call about an appointment for a sigmoidoscopy which I was expecting.
The secretary said that I had to stop taking Apixaban for 5 days prior to the appointment. I queried this but she said the consultant had requested it.
I’m not happy about stopping Apixaban for that length of time.
I’ve been taking it for about 5 years now with no problems.
Has anyone else had a similar experience?
Usually DOACs aren't stopped as early as warfarin, which can be 5 days before, but he may have good reasons for his stance on this. I would try not to be concerned. I doubt the endoscopy dept. has a higher rate of post procedure stroke because of this. Having already queried it you are a bit stuck. You could ask your GP but they are likely to acquiesce to cons request.
How long have you been taking Apixaban ? My experience with a much older anticoagulant, Warfarin is that it is no great deal BUT …. what were you told about restarting it ?
I understand your concerns, I always hate the idea of being off my Apixaban -despite having had to be dragged metaphorically kicking and screaming to take anticoagulants in the first place! Now I’m on them it feels like a security I don’t want to be without.
There’s other threads on here you could find via a search, where I’ve been reassured by people’s posts about how low the risk of stroke is when off anticoagulants for a procedure or surgery. My own cardiologist told me the same recently, and said fine to go ahead with 3 days off Apixaban before a gall bladder removal.
The reason for being off anticoagulation for endoscopies, colonoscopies & sigmoidoscopies is apparently the bleed risk if there’s any damage during the procedure, and so they can take a biopsy or remove polyps.
But I’d say that 5 days does seem a very long time to need to stop a DOAC like apixaban. I thought my 3 days was a bit excessive, but looking up the NICE guidelines I can see that anything that carries a ‘high bleeding risk’ requires 3 days off Apixaban. I’m not sure why they would be extending it to 5 days though, that’s not mentioned in NICE. If you’re worried, there’s no harm going back to the secretary and asking if the consultant could explain why 5 days are required here, as you’re concerned about the stroke risk? There may be a good reason that we don’t know about. But it’s fair enough to ask, so at least you understand.
Good luck, do let us know if you find out more, and how you get on. Jx
I had my pre-op this week - also for gallbladder removal and have been told to stop Edoxaban for the 2 days prior to procedure, so that's 3 doses in total.
When I had my ablation last November it was the same.
Also I had a week in hospital with an inflamed gallbladder earlier this year and the stopped the Edoxaban for 4 days, just in case they needed to operate. A bit unnerving but on the 5th day they gave me it by injection.
Poor you with your gall bladder troubles 😕 I sympathise… Good luck with your surgery - when is it booked for?
Interesting to hear they want you off for 2 days prior, 3 doses in total, that sounds reasonable and in keeping with the NICE guidelines. My hospital (or surgeon maybe) insists on 72 hours prior (3 full days) prior. I don’t know what happens after, if you go straight back on or not!
It must have been doubly worrying for you having to be off anticoagulants when you were in hospital with an inflamed gallbladder, I hadn’t thought of that happening. I’m trying to decide whether to go forward with managed/planned gallbladder removal, or just optimistically leave it in case I can get away with not ever having it. But your experience makes me realise there can be a downside to leaving it until it’s urgent/serious!
I’m so glad you’ve been fine when you’ve had to miss your anticoagulation, that’s reassuring for all of us! I hope your surgery goes well xx
Thanks Jane. Yes it was a bit of a worry but I was more concerned about the pain which was pretty bad 😳. I was back in overnight last month with pancreatitis so will be relieved to have the gallbladder gone. Waiting for an appointment now. Most are done as a day patient now but I will have to stay in overnight because of the permanent AF and Pacemaker.
Ugh that sounds tough 😖 V glad you are getting your gallbladder out, hopefully that will prevent any more such attacks. And hope it’s soon!
I was told would be a ‘few days stay’ due to other conditions, though I imagine like for you they’ll plan for just overnight when it comes to it. Much as I’d prefer not to stay at all in hospital, I think it’ll be reassuring to be in the right place and be cared for over the crucial post-op time, won’t it? X
I would also query again, 5 days for for Wafarin I could understand but not for DOACs.
Hi Marie.
I’m on a DOAS and I had a back tooth extracted months ago. I did not take it on the morning of my appointment (I skipped it and just took the evening dose). There was no excessive bleeding at all.
They could provide alternatives, including short-term therapy with a deferred anticoagulant that lasts for a much shorter period of time. That's a sort of 'meet you half way' solution.
It's worth asking your medic about.
Paul
I had a sigmoidoscopy last month and only stopped Apixaban the night before the procedure. Even for my hysterectomy a few months ago I only stopped 2 days before. I have previously stopped for 7 days in total for an op.
Five days does seem extreme so I would query it.
I had an angio last week and was advised to stop apixaban 1 day prior, and I’m having a colonoscopy/gastroscopy this week and have to stop my apixaban 3 days prior.
Surely not! 5 days for a sigmoid proceedure?No really ,I have had polyps removed, I DAY off Apixaban .
Please check on this!
If you really do need to be off DOACs fir that amount of time,something else needs to bridge the gap, Clopodrogel I think it's called
Xx
I was just scheduled for a full colonoscopy. I've been told to stop Apixaban 48 hours before. I'd want to see the medical evidence for being off for 5 days for a simple sigmoidoscopy.
yes I had a sigmoidoscopy two w stpping it eek ago didn't couldntbdo it as prep hadn't worked so having another in three weeks only had to stop apixoban for three days same when I had a colonoscopy five days seems excessive for that procedure I'd buried that I was fine with 3 days
sorry meant to put I'd quiery it not bury it lor good luck
meant I had a sigmoidoscopy two week ago and only stopped apixoban for 3 days having another in few weeks as the bowel prep hadn't worked so hence having to have another one but same thing only need 3 days off apixobaban have had colonoscopy before to remove polyps and 3 days off apiixoban I'd be worried about five days could understand if it was a major operation but for a simple procedure like that very excessive you definitely need to question that sorry about my previous jumbled message best of luck
I had a colonoscopy on Thursday last and I was told no need to stop my Edoxaban for that procedure.
However on my next appointment for a polypectomy I will need to stop 3 days prior.
They couldn’t remove the polyp at the time due to my ac medication and also because they can’t use diathermy due to my pacemaker so I need to return to another local centre shortly that has the necessary equipment to deal with me …
My primary care physician gave me a study from a major medical journal that said 24 hours was plenty. The doc doing my colonoscopy wants 2 days. She wanted 2 days five years ago. She wanted 2 days ten years ago too. The journal article was from 2023. Doubt if she read it. Doctors are as habitual as the rest of us, and find change difficult.
Husband has had lots of colonoscopies and is always told to stop for 48 hours. Perhaps your consultant has had a bad experience? Did the the secretary ask him/her again or just reiterate what she had written to you. GP surgery could query it for you?
Definitely query this. There are quite a few academic medical articles on line warning about the potential impacts of sudden discontinuation of apixaban and other anticoagulants before operations and the lack of consideration of potential stroke. The advice I read was that there should be some analysis of individual reactions as hematology varies from one person to another and the general advice was to try to minimise the time of withdrawal. 5 days sounds like an unnecessary risk for something which as a half life of 12 hours!. You may be unpopular by challenging it but ask for a second opinion from someone fully cognisant of the risk factors. In fact ask them to quantify your level of risk and put it in writing,
For my gastroscopy this year I was asked to stop apixaban on the day of the procedure. Same when I had an eye op. At Mootfields. I would question 5 days.
I'm having a lung biopsy next week and have been told to stop my Edoxaban 3 days beforehand. I'm happy to do this as I don't want a bleed from the procedure. But I'll be super careful over the next few days to avoid going into A Fib.
The risk of stopping suddenly is not about going into a fibs necessarily. The drug itself from suddenly stopping can cause blood clots leading to stroke, heart attack, especially in the first 30 days from what I’ve read. I believe it’s a 3% risk. That’s why even when someone has an ablation and the doctor takes us off, a natural protocol at least for few months during transition is probably wise. It’s mind boggling how many doctors don’t understand the black box warning about stopping suddenly.
I put this on not to scare anyone, just to share what I’ve learned to help. I research a lot.
For surgery it has to be stopped or the risk is you have prolonged bleeding. I have had to stop it several times for surgery and procedures and if staying in hospital was given heparin injections after to cover me until I could restart Apixaban.
I had a minor operation to remove two large moles on my back and was not asked to stop Apixaban, just delay the next dose until after the operation. No problems for me and no extra bleeding.
All the best.
Roy
I have had a few ops and had to stop 3 days before. However when I was rushed into hospital and found to have infected appendix which needed removal then would not operate until my blood was clear of anticoagulant (Rivaroxaban). So I had blood tests everyday and was not given the all clear for 5 days. I had appendix removed by key hole surgery. So I will sit on the fence lol
I find that v interesting that they could test to see if it’s out of the system, as we are generally told there’s no blood test to confirm we are anticoagulated when on one of the DOACs. Have you any idea what the test was called?
If a DOAC can show some presence up until 5 days, that’s quite reassuring for those of us who worry about missing a couple of doses (unless you need an emergency op like you of course! Hope you recovered ok?) xx
I have no idea what the test was called, it was done daily at about 11 am, never with any of the other blood tests that I had. the last tablet I had taken was Sunday night. I was feeling pretty rubbish, being pumped with several types of antibiotics, fluid drip, sickeness and pain killers and morphine. I was sure it would be clear by Wednesday, no go, Thursday I was praying it would be clear again no. I was beginning to give up but Friday clear. Within two hours I was in surgery. Recovery was good, with keyhole you hardly know that anything has happened, just a few tiny holes in the abdomen, but you do have to be careful for a month with lifting and carrying anything heavy. The doctor said that although you feel fine and hardly any signs of surgery, internaly a lot has happened and you need to give it time to heal.
I had to stop my apixaban for 5 days prior to surgery this year, I was anxious but got through it.
I’m currently in hospital having suffered 2 major posterior nosebleeds in the last week. My first began on Tuesday morning before my dose. I restarted on Friday morning. My second started on Saturday night before my dose. Currently the doctor wants me off for another 5 days. This post is making me feel very nervous and worried. I missed 6 doses then took 3 doses. Now by the time I see the doctor again on the rounds tomorrow morning I will have missed another 6 doses and he wants me off for days more
I can understand it. The nosebleeds were bad and painful to stop. But I’m feeling vulnerable here.
Recently had sigmoidoscopy and was told to stop Edoxoban the day before the procedure
Had a gastroscopy on Tuesday. Told not to take any Apixaban on Tuesday i.e, skip dose before and after. Back to normal next day. 5 days seems like a lot.
5 days seems a long time. I came off for 3 days for a colonoscopy and my last hip op. I had to have a blood transfusion after the hip op so I reckon I bled a lot anyway!
5 days for warfarin makes sense. But that is a long time for apixaban seems long. I had a messy tooth extraction a one only needed to be off it for 3 days. Still, I bled like the dickens. Maybe the dr you’re seeing has had some difficulties w patients in apixaban in the past?
I've been advised to stop taking Apixaban for 3 days before lithotripsy which has a high bleed risk. I looked up various studies and the recommended time to be off it was a lot less. I think it was something like 48 hours for high bleed risk and 24 hours for low bleed risk. I've stopped my Apixaban for 48 hours before each of 6 lithotripsies that I've had with no ill effects. I think the medical profession is unnecessarily fearful and wanting to cover themselves without sufficient detailed knowledge of anticoagulants.
I spoke to a gastroenterologist and he said only to stop it the morning of the procedure for a flexible sigmoidoscopy. Therefore do double check as others have said. All the best.
Hi I recently have been told to stop apixaban 3 days before a procedure spoke with the doctor and he said it was safe as you would be returning to your regular dose after the procedure
good luck
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