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Periprocedural anticoagulation — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Periprocedural anticoagulationUSMLE Step 3

A 74-year-old man with nonvalvular atrial fibrillation takes apixaban and has normal renal function. He is scheduled for colonoscopy with removal of a 25-mm polyp. He has no recent stroke or mechanical valve. What is the best periprocedural plan?

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Correct answer: A — Hold apixaban 2 days without bridging; resume 48–72 hours later if hemostasis is secure

The best answer is “Hold apixaban 2 days without bridging; resume 48–72 hours later if hemostasis is secure”. A large-polyp resection is high bleeding risk. With normal renal function, apixaban is held for 2 days, heparin bridging adds bleeding without benefit, and postprocedural resumption is delayed 48–72 hours when hemostasis is secure. Apixaban is generally stopped 1–2 days before an elective procedure, without heparin bridging, and resumed 48–72 hours after a high-bleeding-risk procedure when hemostasis is secure.

Reference: CHEST Perioperative Antithrombotic Guideline: https://journal.chestnet.org/article/S0012-3692(22)01359-9/fulltext