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Perioperative Anticoagulation — ESEGH MCQ

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HardHematologyPerioperative AnticoagulationESEGH

A 71-year-old taking apixaban has normal renal function and is scheduled for endoscopic mucosal resection of a 25 mm colonic lesion. When should the last apixaban dose be taken?

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Correct answer: C — Three days before the endoscopic resection

Endoscopic mucosal resection is a high-risk procedure. The 2021 BSG/ESGE update recommends that the last dose of a factor Xa inhibitor be taken three days before high-risk endoscopy; the longer five-day interval applies to dabigatran when renal function is reduced.

Reference: BSG/ESGE guideline update: endoscopy in patients on antiplatelet or anticoagulant therapy (2021 update with June 2024 addendum): https://www.bsg.org.uk/clinical-resource/updatet-endoscopy-in-patients; BSG/ESGE antiplatelet and anticoagulant guideline update — full guideline (Published 2021): https://www.bsg.org.uk/getattachment/f6eb5089-363e-41e1-b38a-4d718e2d9a70/BSG_ESGE-antiplatelet-and-anticoagulant-update-2021.pdf