Dear Dr. Roach: My doctor wants me to have a colonoscopy, but I would have to be off Xarelto for five days. The last time I did this I had a small stroke.
P.D.
Xarelto is an anticoagulant, used in people who are at high risk for developing a blood clot. This may include a previous history of a blood clot in the legs or lungs, atrial fibrillation, mechanical heart valves or other reasons.
For people with a high risk of complications if an anticoagulant is stopped, most experts recommend performing a screening colonoscopy without stopping the anticoagulation. However, if the colonoscopy is being performed to remove a large polyp, for example, then there is a significant risk of bleeding if the anticoagulant isn’t stopped. In these cases, the risk of bleeding must be weighed against the risk of a clot, which can cause a stroke.
I am surprised at the length of time you mention. Five days is usually not necessary with rivaroxaban (Xarelto) and similar medicines. The most recent paper I read suggested that restarting the next day is generally safe for most people after a polyp removal.
Ask the gastroenterologist performing your colonoscopy to talk with the doctor prescribing the Xarelto, so they can consider all the risks and recommend the best course.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
