# Anticoagulants and antiplatelet drugs around elective endoscopy and endoscopic biopsy

Source: https://onco.cc/protocols/anticoagulants-and-antiplatelets-before-endoscopy/  
OnCo record `anticoagulants-and-antiplatelets-before-endoscopy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

If you take a blood thinner or a drug like aspirin or clopidogrel, tell the team well before an endoscopy or colonoscopy. For a simple look with small biopsies most people carry on, perhaps missing one morning dose. For riskier procedures, such as removing polyps, the team will say which drug to stop, for how long, and when to restart. Never stop a heart or clot medicine on your own.

## Summary

BSG/ESGE 2021 (GRADE) sorts procedures by bleeding risk (low: diagnostic endoscopy with or without biopsy, stenting, EUS without sampling; high: polypectomy, endoscopic resection, ERCP with sphincterotomy, EUS-guided sampling, PEG and others) and patients by thrombotic risk. Everyone is told both the thrombotic risk of stopping and the bleeding risk of continuing (strong, low). Aspirin continues for all procedures except ampullectomy (strong, low). Low-risk procedures: continue P2Y12 inhibitors, single or dual (strong, low); continue warfarin with an INR within range in the week before (weak, low); omit the morning DOAC dose (weak, low). High-risk procedures, low thrombotic risk: stop P2Y12 inhibitors 7 days before (strong, moderate) keeping aspirin; stop warfarin 5 days before with INR below 1.5 (strong, high); last DOAC dose 3 days before (strong, low), 5 days for dabigatran with clearance 30 to 50 ml/min. High thrombotic risk: keep aspirin and discuss P2Y12 interruption with an interventional cardiologist (strong, high); bridge warfarin with LMWH (strong, low). Restart within 2 to 3 days (strong, moderate). ACG-CAG 2022 (GRADE, all conditional) differs: it suggests continuing warfarin for elective endoscopy generally and suggests against heparin bridging when warfarin is held, suggests interrupting DOACs rather than continuing them, suggests not interrupting aspirin for secondary prevention, interrupting the P2Y12 inhibitor but not aspirin on dual therapy, and could not recommend on resumption timing.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: stopping blood thinners before endoscopy; warfarin before colonoscopy; DOAC before endoscopy; apixaban before endoscopy; rivaroxaban before colonoscopy; clopidogrel before endoscopy; aspirin before endoscopy; heparin bridging endoscopy; antithrombotics and polypectomy

## Connected records

- protocols: [Blood thinners around cancer surgery, biopsy and endoscopy: when to stop, whether to bridge, when to restart](https://onco.cc/protocols/antithrombotic-interruption-around-surgery/), [Diagnostic flexible bronchoscopy and EBUS: preparation, sedation and aftercare](https://onco.cc/protocols/diagnostic-bronchoscopy-and-ebus-preparation/), [Image-guided core needle biopsy of the breast and liver: preparation and aftercare](https://onco.cc/protocols/image-guided-core-biopsy-preparation-and-aftercare/)
- technologies: [Cancer-associated thrombosis prevention and treatment](https://onco.cc/technologies/cancer-associated-thrombosis/), [Endoscopic resection (EMR / ESD)](https://onco.cc/technologies/endoscopic-resection/)
- drugs: [Aspirin](https://onco.cc/drugs/aspirin/)
- terms: [Colonoscopy](https://onco.cc/terms/colonoscopy/), [Endoscopy (EGD, EUS, ERCP)](https://onco.cc/terms/endoscopy/), [Venous thromboembolism (VTE)](https://onco.cc/terms/vte/)
- ideas: [Guidance on treatment-dose low molecular weight heparin for a cancer clot around endoscopy](https://onco.cc/ideas/idea-pu-lmwh-plan-around-endoscopy/)

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