Colonoscopy procedure scheduled

Dr. Natale said I could be off my Eliquis for ONE day. I take my Eliquis at 8 2X a day. My colonoscopy is scheduled for 8 AM On a Friday. When do I stop my Eliquis? I am thinking I will have to stop it after Wednesday nights dose. For some reason it’s confusing and my Anxiety is ramped.
I cannot do the cologuard due to family history making me “risky”.
Thanks for the help.

Stop the apixaban after the first dose on the previous day. So, take the 0800 dose, but skip the evening one. My own EP wants me to take five 'baby' aspirin starting at the apixaban missed evening dose, but three in the evening over about four hours and two the next morning. Then, in the hospital you swallow a Plavix about an hour prior to surgery. That's my experience, anyway.

Apixaban has a half-life of approximately 12 hours. That means by 18 hours, you still have about 35-40% bioavailability in your system from the previous dose. But there is also a residual effect that lasts longer. So, don't feel squeamish about missing that evening dose, but you should have other instructions about getting yourself safely to the actual time of surgery. Nothing?

I agree with gloaming about stopping the night before.

But I don't think substituting aspirin makes sense with a colonoscopy. The whole point is that if the doctor needs to snip a polyp, you don't end up with a prolonged bleed, and aspirin does a fine job of prolonging bleeding. I don't think I've ever heard of an EP or surgeon recommending the protocol with aspirin and Plavix that you describe. Over 400 mg of aspirin followed by Plavix? I think that would prolong bleeding more than Eliquis would.

Carey, what can I say. It was how it went for me during an angiography last March (I have to correct myself, it was during an angiogram, not during my CA. The protocol was the same, though, except for the Plavix). It seemed weird to me as well, but I wasn't in a position to arm-wrestle with the nurses and surgeon. Not flat on my back, anyway.

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smackman
Dr. Natale said I could be off my Eliquis for ONE day. I take my Eliquis at 8 2X a day. My colonoscopy is scheduled for 8 AM On a Friday. When do I stop my Eliquis? I am thinking I will have to stop it after Wednesday nights dose. For some reason it’s confusing and my Anxiety is ramped.
I cannot do the cologuard due to family history making me “risky”.
Thanks for the help.

Wondering if your LAA is isolated and you have a Watchman?

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gloaming
Carey, what can I say. It was how it went for me during an angiography last March (I have to correct myself, it was during an angiogram, not during my CA. The protocol was the same, though, except for the Plavix). It seemed weird to me as well, but I wasn't in a position to arm-wrestle with the nurses and surgeon. Not flat on my back, anyway.

Oh, it was an angiogram. I bet they were thinking they might need to place a stent so they wanted aspirin onboard in advance. Anti-platelet drugs like aspirin and Plavix are often used with stents, not so much with colonoscopies. Way different situations. I think the gastroenterologists just don't want bleeding obstructing their view during the procedure or delaying your discharge because you've been dribbling blood out of your butt for 2 hours.

LAA is isolated (2016) and No Watchman. I tried one time in 2019 for watchman but did not get approved.
Anyway, It is what it is.
The process and BS to get approval in 2019 was big time stressful and time consuming.

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smackman
LAA is isolated (2016) and No Watchman. I tried one time in 2019 for watchman but did not get approved.
Anyway, It is what it is.
The process and BS to get approval in 2019 was big time stressful and time consuming.

Are you tempted to try for a watchman again? It seems like if your LAA is isolated and you flunk your TEE that Medicare is approving a watchman these days.

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Daisy
Are you tempted to try for a watchman again? It seems like if your LAA is isolated and you flunk your TEE that Medicare is approving a watchman these days.

Definitely try again. The criteria have changed completely since 2019. I doubt you'll run into any major roadblocks this time. If you had a Watchman, Natale's answer would have been "Just stop the Eliquis for as long as the doctor wants."

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Carey
I agree with gloaming about stopping the night before.

But I don't think substituting aspirin makes sense with a colonoscopy. The whole point is that if the doctor needs to snip a polyp, you don't end up with a prolonged bleed, and aspirin does a fine job of prolonging bleeding. I don't think I've ever heard of an EP or surgeon recommending the protocol with aspirin and Plavix that you describe. Over 400 mg of aspirin followed by Plavix? I think that would prolong bleeding more than Eliquis would.

What you are saying is only 12 hours off Eliquis not 24. I know the half life but 1 day is 24 hours right? I guess I could lie when I get there but if they snip a polyp or two, is that a risk? It took me 2 months to get approval for this Colonoscopy over this blood thinner.

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smackman

What you are saying is only 12 hours off Eliquis not 24. I know the half life but 1 day is 24 hours right? I guess I could lie when I get there but if they snip a polyp or two, is that a risk? It took me 2 months to get approval for this Colonoscopy over this blood thinner.

If you go back to gloaming’s post, (and Carey agreed) the suggestion was to take your Thursday a.m. dose and stop after that — this would be 24 hours. Good luck with the colonoscopy!

Half-life after 24 hours would be approximately 0.25 of the last dose still swilling around doing you good. But, as I was careful to add originally, there is a 'residual' effect that the physicians and nurses know about, and it is why they routinely ask new patients how long they have been taking apixaban, and how regularly. This is important because, even if a person has missed two or more recent doses, the residual effect otherwise (the person has been meticulous about taking it as prescribed) will help to reduce the risk. That means, in turn, that there is a latent efficacy even after 36 hours of missed doses of this one relevant drug.

Twice now, I have been ordered to cease taking apixaban after the morning dose THE DAY PRIOR to either an angiogram or a catheter ablation. This puts me near 24 hours after the last dose (I take mine at the twelves).

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smackman
What you are saying is only 12 hours off Eliquis not 24. I know the half life but 1 day is 24 hours right? I guess I could lie when I get there but if they snip a polyp or two, is that a risk? It took me 2 months to get approval for this Colonoscopy over this blood thinner.

See Daisy's post. You'll be off Eliquis for 24 hours if you follow gloaming's original suggestion.

And yeah, snipping a polyp or two could be a risk. One risk is the doctor can't see other polyps because of the continuous bleeding from the first one they snipped. The other is you're not discharged the same day because you've got multiple polyp sites bleeding hours later. And the worst case risk is a nick in the intestinal lining during the procedure. That could bleed significantly and lead to complications.

I don't understand why you're concerned about missing the colonoscopy. Just do as Natale said and you're good to go.

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Carey

Are you tempted to try for a watchman again? It seems like if your LAA is isolated and you flunk your TEE that Medicare is approving a watchman these days.

Definitely try again. The criteria have changed completely since 2019. I doubt you'll run into any major roadblocks this time. If you had a Watchman, Natale's answer would have been "Just stop the Eliquis for as long as the doctor wants."

Perhaps there isn’t a set in stone time one may stop Eliquis after a successful watchman. I was only allowed 5 days off. My GI dr wanted me to stop 3 days before and 2 days after. A week after my last ablation I got a mother of a hematoma. I just stopped for 5 days and it was better.
I don’t think I would risk stopping longer with a chads 5 (6 if you count gender).

My Colonoscopy is scheduled for 8 am Friday morning. If I take Thursday 8am dose of Eliquis, It will work till 8 pm Thursday night. 8 pm Thursday night to the scheduled 8 am colonoscopy on Friday at. 8 am is only 12 hours off Eliquis which is 1/2 of a day. Right? Not 24 hours

I anm only doing math. IWhat am I missing here? Yes, It bothers me to be off Eliquis at all but I have no choice if I want a Colonoscopy done. Most Doctors want touch me unless I am off 2 days.

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smackman
My Colonoscopy is scheduled for 8 am Friday morning. If I take Thursday 8am dose of Eliquis, It will work till 8 pm Thursday night. 8 pm Thursday night to the scheduled 8 am colonoscopy on Friday at. 8 am is only 12 hours off Eliquis which is 1/2 of a day. Right? Not 24 hours

No. Stop complicating this by trying to count from when you think Eliquis quits working. It doesn't stop working after 12 hours, and no doctor expects you to even know the half-life, so no doctor expects you to calculate it that way. Natale said one day. Well, from 8 am Thursday until 8 am Friday is 24 hours, which is one day. It really is that simple. Just pretend you don't know what the half-life is and do as directed.

Actually IMO I am not trying to complicate the Colonoscopy. You are saying what you believe Dr. Natale is saying. I have not talked to anyone at Dr. Natale practice in Austin. I do understand what you are saying within reason. When the nurse ask me next Friday when I last took Eliquis and she/he will, what should I say?
I am not trying to make a mole hill into a mountain. I just do not want to be turned away Friday morning. If I tell her/him I took 2.5 mg Thursday morning at 8 am I just feel it will be an issue.
Thanks for all the help. I am just a EE retired turning 65 in February. I have knowledge of medical only from this forum and other searches for various reasons.

They agreed that one day off Eliquis was adequate, right? If they did, and you tell them the last dose was 8 am Thursday, then they'll be satisfied.

smackman, why have you discounted what I have explained to you rather clearly....twice now? I'm going to guess that it is because you are not familiar with the concepts of 'bioavailability' and of 'half-life'. Or, maybe you're just squeamish about using those concepts as indicators of the effects of a drug. I assure you, as will others who have done the pondering, that it is as valid a concept biologically as it is for the half-life of a radio-isotope like Strontium 90.

If one takes a single, first-ever, dose of 5 mg of apixaban, and follows up with no more tablets, the pill's effect is not going to be over 12 hours, nor over 18 hours. It will last over 36 hours. This is because with each 12-hour period that passes after ingesting it, it will lose only 50% of its effect. Fifty percent is 'half' of what came originally. Then, over the second 12-hour period (now we're a whole 24 hours after the single ingested, first-ever, dose), the drug will drop another 50% of its efficacy. This means that after 24 hours you still have 25% left of the drug bioavailable to do what you need it to do. Thirty-six hours after ingesting the tablet, the serum availability will be small, but still 12% of the original dose.

As I stated earlier, there is also a residual effect over time because the successive dose is ingested, with a prescription requiring periodic doses, BEFORE the preceding dose has reduced to the 25% bioavailability mark at 24 hours. IOW, you are asked, by the prescribing authority, to dose yourself before the previous pill has reduced its bioavailability below the 50% mark, and you do this day after day, week after week. Once the ethical and caring medical staff are assured that you are dosing yourself properly, and have been for some time, they'll be comfortable directing you to cease your second dose on the previous day.

I hope this is clear to you. You are worrying needlessly. The math, and the chemistry, are very much on your side, and your care-givers know this. Enjoy the surgery worry-free. This is what they would like for you.

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gloaming
smackman, why have you discounted what I have explained to you rather clearly....twice now? I'm going to guess that it is because you are not familiar with the concepts of 'bioavailability' and of 'half-life'. Or, maybe you're just squeamish about using those concepts as indicators of the effects of a drug. I assure you, as will others who have done the pondering, that it is as valid a concept biologically as it is for the half-life of a radio-isotope like Strontium 90.

If one takes a single, first-ever, dose of 5 mg of apixaban, and follows up with no more tablets, the pill's effect is not going to be over 12 hours, nor over 18 hours. It will last over 36 hours. This is because with each 12-hour period that passes after ingesting it, it will lose only 50% of its effect. Fifty percent is 'half' of what came originally. Then, over the second 12-hour period (now we're a whole 24 hours after the single ingested, first-ever, dose), the drug will drop another 50% of its efficacy. This means that after 24 hours you still have 25% left of the drug bioavailable to do what you need it to do. Thirty-six hours after ingesting the tablet, the serum availability will be small, but still 12% of the original dose.

As I stated earlier, there is also a residual effect over time because the successive dose is ingested, with a prescription requiring periodic doses, BEFORE the preceding dose has reduced to the 25% bioavailability mark at 24 hours. IOW, you are asked, by the prescribing authority, to dose yourself before the previous pill has reduced its bioavailability below the 50% mark, and you do this day after day, week after week. Once the ethical and caring medical staff are assured that you are dosing yourself properly, and have been for some time, they'll be comfortable directing you to cease your second dose on the previous day.

I hope this is clear to you. You are worrying needlessly. The math, and the chemistry, are very much on your side, and your care-givers know this. Enjoy the surgery worry-free. This is what they would like for you.

First, It was not meant as an insult. I should never feel intimidated with getting 2nd opinions. You only live once.
I will continue to look at others whose opinions may defer from yours or mine. I really enjoy living and it scares the Hell out of me when ask to stop a blood thinner for 3 days. My Gasterologist did consult with Dr. Natale. This has been going on since November 2022.

Today, I get a letter in the mail going over the procedure as expected with one exception; I was told to stop Eliquis one day before the procedure AND stop my baby aspirin 5 days before the procedure.
I have a stent. Because of my stent, I was told to NEVER stop the baby aspirin I talked with my gasterologist assistant about 2 weeks ago and we went over this and it seemed to not be an issue with taking the baby aspirin. I had this stent installed January 2012. Both of my Cardiologist said NOT TO EVER STOP the baby aspirin. Their reason is the possibility of a stroke was more likely than having a bleeder from a colonoscopy. I said 2 Cardiologist because I changed Cardiologist in 2017.
Dr. Natale actually wanted me to take a 325 mg aspirin a day because of the stent. Maybe it’s the type of stent it is or maybe location of stent but that’s outside my wheelhouse.
In 2014, I had a Colonoscopy and my aspirin was not discontinued. That gasterologist has retired.
I now have a call in to my current Cardiologist and the gasterologist about the baby aspirin.

My dosage is 2.5 mg of Eliquis 2x a day. I do not know if that changes anything with explanations above where gloaming used 5 mg as an example for his explanation. I will take 2.5 Thursday morning and stop the aspirin Monday morning. I called my current cardiologist and he did not have an issue with me stopping the aspirin 5 days before this Fridays colonoscopy. He believes after 10 years of having a stent, it should be no problem. He does stents all the time.

If anything the 2.5 mg dosage makes it even less of an issue. You wouldn't be on a half-dose if your risk was high.

In 2016, I had a TEE done 6 months after LAA was isolated. Anyway here is the Conclusion of my TEE. This was performed in Austin.
Summary:
Complications: None
Conclusion:
1. Normal left ventricular systolic function.
2. Normal left atrial appendage emptying velocities.
3. There is no evidence of A waves on mitral inflow.

Continue on Eliquis. 2.5 mg 2x a day. This was Dr. Natale on the dosage amount.

Colonoscopy done. My heart had no issues. This was the 1st time being put to sleep after 2016 Ablations. Anyway, all was good. No polyps etc. I did white coat which is something I struggle with. 170/101. Second time 5 minutes later 150/100.
After Colonoscopy 1 hour later 140/90 which for me is good.
White coating BP started after my struggles with persistent AFIB. I cannot shake it.

We all like to have as much information and as much autonomy as we can, but in a hospital things can always slip out of our grasp or control. There is novelty, some of it unpleasant or potentially so, and we don't tend to respond well learning that there are new developments, or suggested remedies, that bring delays or new treatments. This is stressful. I can't speak for you or for others, but I tend to be stoic in philosophy. When I really have no practical control, fretting just makes it worse, or stewing does. I have to trust the expertise of others, although I do cross-reference it with some previous self-education. I know that discomfort, enduring, and lack of insight, are fleeting, even if they last days or weeks. Inside of six months it is all but forgotten.

It seems things have gone well for you in terms of the procedure, your concerns, and the results. Good for you!