If you take a medicine that thins the blood or stops platelets sticking, we need to plan your test with you. Some of these medicines are continued, some are paused for a set number of days, and some must not be stopped at all without a cardiologist’s agreement. Please contact the Endoscopy Unit at least seven days before your appointment.

The most important thing on this sheet

Do not stop a blood-thinning medicine yourself. Stop it only if the endoscopy team has told you to, and only for exactly the number of days written down for you. Stopping it when you have not been told to is more dangerous than the bleeding risk of the test: bleeding after an endoscopy can nearly always be stopped there and then, whereas a stroke can leave lifelong disability and a heart attack can be fatal.

It depends on which test you are having

Tests are grouped by how likely they are to cause bleeding. Lower-risk tests include a gastroscopy or colonoscopy with biopsies, an endoscopic ultrasound without a needle, and putting a stent into the gullet, bowel or bile duct. Higher-risk tests include removing a polyp, ERCP with a cut at the duct opening, endoscopic ultrasound with a needle, placing a feeding tube, stretching a narrowing, and banding varices. Higher-risk tests are the ones that may need a medicine paused.

Days before a higher-risk test. Solid = keep taking it; dotted = the days it is paused. 1 aspirin, usually continued 2 clopidogrel, prasugrel or ticagrelor, 7 days 3 warfarin, 5 days 4 apixaban, rivaroxaban or edoxaban, 3 days 5 dabigatran, 5 days if kidney function is reduced

What usually happens to each medicine

If you have a heart stent, read this

If a drug-eluting stent was put into a coronary artery within the last 12 months, or a bare metal stent within the last month, stopping your antiplatelet medicine carries a serious risk of the stent blocking. In that situation the decision is not ours alone to make: it must be discussed with the consultant interventional cardiologist responsible for your care. Tell the endoscopy unit about your stent and when it was placed as soon as your endoscopy is booked, so there is time to arrange this.

Afterwards

Any medicine that was paused is normally restarted within two to three days, and warfarin usually the same evening. You will be told exactly when. Do not restart earlier than instructed, and do not delay longer either.

Bleeding after a higher-risk procedure can appear late — most often in the first week or two, by which time you will be back on your medicine, but occasionally as late as a month. Contact the endoscopy unit urgently if you vomit blood, pass black tarry stools or fresh blood, or feel faint or dizzy, at any point in the month after your test.

Two practical things. Bring your anticoagulant alert card, or a full list of your medicines with the doses, to every appointment. And if your test is delayed, cancelled or moved after you have already stopped a medicine, telephone the endoscopy unit — do not simply stay off it until the new date.

Your own plan

Your plan is personal to you and must be written down. Ask the endoscopy unit to complete this before you leave: name of medicine ____________________ · last dose to be taken on ____________________ · first dose after the test on ____________________ · questions to ____________________

For appointments and questions, contact the endoscopy unit using the numbers it has given you. If you are seriously unwell, or it is outside working hours, go to the Emergency Department rather than waiting for a reply. Version 1.0 · review date October 2028.

This leaflet is general information and does not replace advice from your own doctor.