J Gastroenterol Hepatol
Delaying DOAC restart after colonoscopy may raise stroke risk without reducing bleeding
Clinical takeaway: For most patients undergoing outpatient colonoscopy, resuming DOACs within 48 hours appears safe and may better protect against thromboembolic events without increasing clinically significant GI bleeding.
In a large retrospective cohort study of 7,798 adults on DOAC therapy undergoing outpatient colonoscopy within an integrated U.S. health system, investigators examined outcomes based on timing of anticoagulant resumption. Patients were grouped into early restart (<2 days) or delayed restart (≥2 days). Over 30 days of follow-up, delayed DOAC resumption wasn’t associated with a reduction in overall or clinically significant GI bleeding, even in a cohort where polypectomy was common. In contrast, delayed resumption was associated with a significantly higher risk of thromboembolic events, driven largely by ischemic stroke. Absolute event rates were low but consistently favored earlier restart. The findings help address a key evidence gap cited by gastroenterology societies and suggest that concerns about post-colonoscopy bleeding may be overstated relative to the risks of prolonged anticoagulant interruption.
Source:
Leung LJ, et al. (2026, March 23). Clin Gastroenterol Hepatol. Timing of Direct Oral Anticoagulant Resumption After Outpatient Colonoscopy and Risk of Gastrointestinal Bleeding and Thromboembolic Events. https://pubmed.ncbi.nlm.nih.gov/41887551/
