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Key takeaways
Eliquis may increase the risk of bleeding during a colonoscopy.
For one-time or routine colonoscopies, Eliquis is usually paused 24 to 72 hours before to reduce the risk of bleeding during and after the procedure.
Following your healthcare provider’s guidance on pausing and resuming Eliquis for this procedure is crucial in reducing your risk of major bleeding, or conversely, blood clots or stroke.
Because Eliquis (apixaban) is designed to thin the blood and increase blood flow, medical experts recommend pausing it before a colonoscopy. If you have an upcoming colonoscopy for colorectal cancer screening or to diagnose another condition and are taking Eliquis, it’s best to stop taking it one to three days before the procedure.
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How long do you have to be off Eliquis before a colonoscopy?
The procedure’s risk and the patient’s overall health determine how long a patient should pause Eliquis before a colonoscopy, according to Elizabeth Rubin Ribak, MD, a board-certified emergency medicine physician and clinical advisor at Embers Recovery in Phoenix, Arizona.
“The risk of stroke and bleeding differs for each patient depending on scores like CHA₂DS₂-VASc and HAS-BLED,” says Dr. Ribak. “Personally, I like to highlight the importance of shared decision making between myself and the patient, with guidance depending on testing results or whether the procedure is diagnostic or anticipates polypectomy or endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD). Our goal when adjusting Eliquis to prepare for a colonoscopy is to balance protection with safety.”
“Since in most instances we do not know beforehand what we are going to find during the actual colonoscopy, most gastroenterologists use a standard schedule when holding blood thinners before a colonoscopy,” says Jesse P. Houghton, MD, FACG, Senior Medical Director of Gastroenterology at Southern Ohio Medical Center and member of the SingleCare Medical Review Board. “As Eliquis will be out of most patients’ systems in 48 hours, many gastroenterologists will hold Eliquis for two days prior to endoscopic procedures such as a colonoscopy.”
Here’s a breakdown of the window of time Eliquis must be paused before a colonoscopy as part of bowel prep instructions:
Low- and moderate-risk colonoscopy
“If the colonoscopy is low risk and just a screening exam, then the medication can be paused starting about 24 hours beforehand,” explains Gail Clifford, MD, a hospitalist and medical consultant at ARRC LED of Orlando, Florida. “Patients taking Eliquis who have healthy kidneys can clear the drug without issue during this time frame prior to a colonoscopy.”
Low-risk screening colonoscopies typically don’t require a long window between pausing Eliquis and the procedure. “For low-risk procedures like a screening colonoscopy with or without small biopsies, many clinicians instruct patients to continue their normal schedule of Eliquis but skip the most recent two doses prior to the procedure, or an alternative is taking the last dose two days prior to the procedure,” Dr. Ribak says.
High-risk colonoscopy
If the colonoscopy is a high-risk procedure that may involve polyectomy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD), which are all techniques that surgically remove polyps, Dr. Ribak says your healthcare provider may recommend taking your last Eliquis dose three days prior. “These windows reflect assumptions for average thrombotic risk and normal drug handling,” she says.
Colonoscopy with kidney or liver impairment
If you have renal impairment, such as a medical history of chronic kidney disease (CKD), Dr. Clifford says that you may need to pause Eliquis three days before the procedure. This is because Eliquis can stay in your system longer when you have impaired kidney function along with age >80 years or body weight <60 kg.
People with liver disease will also need to be extra careful with Eliquis, as it is mainly metabolized by the liver. Those with cirrhosis should avoid Eliquis unless otherwise instructed by their provider.
Moderate to high-risk colonoscopy to remove polyp or tumor
If you’re going in for a moderate to high-risk colonoscopy that involves the removal of a large polyp or tumor, medical experts recommend pausing Eliquis for at least 48 hours.
If the colonoscopy involves a biopsy or polyp removal, Eliquis will likely need to be paused a few days prior to reduce the risk of bleeding. Risk factors for post-polypectomy bleeding include the use of anticoagulant medicines and large (>1 cm) polyps, according to research published in The American Journal of Medicine.
Eliquis vs. other blood thinners before a colonoscopy
While bleeding after a colonoscopy on blood thinners is a major concern, Eliquis actually has a lower risk than other anticoagulants like warfarin.
“When compared to other blood thinners, warfarin needs to be stopped earlier at around four days before the procedure, while Xarelto and Pradaxa have timelines similar to Eliquis,” Dr. Clifford says.
Why does Eliquis need to be stopped before a colonoscopy?
“The reason for pausing is because Eliquis thins the blood and prevents it from clotting, meaning that even a small nick in the colon can cause excessive bleeding if the drug is still active,” Dr. Clifford explains. She adds that for higher-risk colonoscopies, skipping just one dose of Eliquis is unsafe. “Skipping just the morning dose isn’t an option for patients since it leaves too much of the drug still circulating and won’t lower the risk of bleeding enough.”
Pausing or holding vs. discontinuing
When it comes to preparing for a colonoscopy while taking Eliquis, it’s crucial to understand the difference between “holding” and permanently discontinuing the blood thinner medication. “Pausing or holding the medication is a temporary break from taking the medication before and after the procedure, rather than quitting the drug completely,” Dr. Clifford explains.
When can you restart Eliquis after a colonoscopy?
What is found during a colonoscopy will determine when it’s safe to resume Eliquis, according to Dr. Ribak. She adds that this can be the next scheduled dose after a low-risk colonoscopy without polyp removal, up to 48 to 72 hours after a higher-risk procedure where large polyps are removed. “To note, some administer the first apixaban dose the evening of an uncomplicated colonoscopy, then resume normal dosing schedule the next day.”
When resuming Eliquis, it’s crucial that you don’t start taking it too soon or too late. “Restarting too soon could cause post-procedure bleeding, yet waiting too long could increase the risk of clotting or stroke,” Dr. Clifford explains. “Patients realize that managing Eliquis is like a delicate dance where we must time every step just right to keep both bleeding and clotting safely in check.”
“To decrease the risk of bleeding after removing polyps during a colonoscopy (termed post-polypectomy bleeding), we will often place endoscopic clips at the base of the removed polyp, which act like temporary staples to prevent that spot from bleeding,” says Houghton.
If you have concerns about Eliquis and colonoscopy prep, always reach out to your healthcare provider for professional medical guidance.
- Management of anticoagulants and antiplatelet agents during colonoscopy, The American Journal of Medicine (2017)
- The risk of colonoscopy-related bleeding in patients with or without continued treatment with an antithrombotic agent, DEN Open (2025)
- Elizabeth Rubin Ribak, MD, of Embers Recovery
- Gail Clifford, MD, MMM, CPE, FACP, FHM, of ARRC LED