Periprocedural DOAC Management — ESEGH MCQ

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ModerateHematologyPeriprocedural DOAC ManagementESEGH

A 50-year-old woman with microcytic anaemia and positive faecal occult blood test is scheduled for EGD and colonoscopy. She takes rivaroxaban for atrial fibrillation. Which is the most appropriate periprocedural management of her anticoagulation?

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Correct answer: D — Hold rivaroxaban for 48 hours before the procedure; no bridging anticoagulation

For diagnostic EGD and colonoscopy (low-risk procedures), the BSG/ESGE 2024 addendum exemplifies stopping rivaroxaban 48 hours preoperatively—allowing ~5–6 half-lives and >97% drug clearance—with no bridging anticoagulation. This aligns with the PAUSE trial finding of safety with 1-day preendoscopy interruption and contemporary consensus. Rivaroxaban should be restarted 1–2 days postoperatively. Option E (bridging with LMWH) is incorrect; bridging is not recommended for DOAC interruption in low-risk endoscopy and increases bleeding without reducing thromboembolic risk. Option A (vitamin K) is inappropriate for routine DOAC management and has no role in periprocedural endoscopy anticoagulation. Option C (continue) and option B (hold only on the day) both leave inadequate time for drug clearance.

Reference: British Society of Gastroenterology / European Society of Gastrointestinal Endoscopy, Addendum: Endoscopy in Patients on Anticoagulant Therapy (June 2024); Veitch AM, et al., Endoscopy in patients on antiplatelet or anticoagulant therapy: BSG/ESGE guideline update, Gut 2021;70:1611–1628. https://www.bsg.org.uk/getmedia/68b5cf32-aa6a-49f7-af56-b85fc5f6a3e9/Addendum-Antiplatelet-03-06-24.pdf