Gastroenterology and Hepatology

Upper Endoscopy and Colonoscopy

• Some medications (prescription and over-the-counter) can reduce your body’s ability to form blood clots and taking these before GI endoscopy procedures may increase your risk of bleeding during and after these tests. For this reason, it is generally recommended to withhold certain drugs if you are scheduled to have one of these procedures performed. These are sometimes referred to as blood thinners.
• The decision about whether to stop any medication is always based on an estimate of the risk of having a significant medical problem during the short time that you are off of them compared to the risk of bleeding complications from the procedure you are to undergo.
• For medications used to treat arthritis (regular dose aspirin or nonsteroidal anti-inflammatory drugs, also known as NSAIDs), there is little or no risk to stopping these, but you may have more arthritis pain or swelling. They are usually stopped for four (4) days prior to any procedure. It is safe to take acetaminophen (Tylenol) before an endoscopy for arthritis pain or headaches.
• For aspirin (81 or 325 mg daily) used to prevent heart problems, this is usually safe to stop for seven (7) days prior to any procedure. If you have severe heart problems you may need to consult with your heart specialist to determine if it is safe to stop it.
• For anti-platelet drugs it is usually important to speak with your heart doctor, vascular surgery specialist, neurologist or primary physician to determine if these are safe to stop. These are usually stopped for seven (7) days prior to any procedure.
• For anti-coagulant drugs it is almost always important to consult with the prescribing physician to determine if it is safe to stop them and for how long. For most people who are taking Coumadin (Warfarin) for chronic heart rhythm problems (like atrial fibrillation) it is usually safe to stop it for four (4) days prior to the procedure. However they may be special circumstances where the medication is not stopped or other medications are used to prevent clotting after it is stopped. You should get specific advice from your doctor on how to handle this.

Below is a list of many medications (but not all) that fall into these categories. It is important to remember that there are hundreds of over-the-counter medications that contain NSAIDs or aspirin, so it is important to carefully read the label of any medication that you are taking (prescription or over-the-counter).

Nonsteroidal anti-inflammatory medications – NSAIDs (generic name in italics):

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Diclofenac (Cataflam, Voltaren, Arthrotec) Diflunisal (Dolobid) Etodolac (Lodine) Fenoprofen (Nalfon) Flurbiprofen (Ansaid) Ibuprofen (Motrin, Advil, Motrin IB, Nuprin) Indomethacin (Indocin) Ketoprofen (Actron) Meclofenamate (Meclomen) Mefenamic Acid (Ponstel) Meloxicam (Mobic) Nabumetone (Relafen) Naproxen (Naprosyn, Naprelan, Anaprox, Aleve) Oxaprozin (Daypro) Piroxicam (Feldene) Salicylates (sodium salicylate, Magan, Mobidin, Mobogesic, Arthritab, Bayer Select, Doan’s pills) Salsalate (Amigesic, Marthritic, Salflex, Slasitab) Sulindac (Clinoril) Tolmetin (Tolectin)

Anti-platelet drugs:

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Aspirin (present in many medications) Cilostazol (Pletal) Clopidogrel (Plavix) Dipyridamole (Persantine) Dipyridamole/Aspirin (Aggrenox) Eptifibatide (Integrilin) Pentoxifylline (Trental) Ticlopidine (Ticlid) Tirofiban (Aggrastat)

Anti-coagulants:

Heparin Low Molecular Weight Heparins (Fragmin, Lovenox, Danaparoid) Warfarin (Coumadin)

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