Arrhythmia and Prep for Colonoscopy

Posted by ajnewyork @ajnewyork, Aug 24, 2022

I'm wondering if anyone has any experience with colonoscopy prep prescriptions causing abnormal heart rhythms.

I developed atrial flutter in early 2021 and have since had to have two ablations and one pacemaker implantation to correct symptomatic bradycardia. Between the procedures, I have had episodes of tachycardia, some lasting for days. Symptoms have been mostly under control for the past two months through taking a low dose of metoprolol succinate.

I've scheduled a colonoscopy and my cardiologist's office has provided a detailed medical history to the gastroenterologist who will perform it (in a hospital). I've just noticed that the prep prescription ordered by the gastroenterologist lists abnormal heart beats as a "rare" side effect and mentions (in bold) that people with heart problems are more likely to have them.

Of course, I'll consult with both of my doctors, but if anyone has any experience that they could share, I'd be grateful. I did a little web research and it appears that other preps have the same or a similar listing.

Thanks so much.

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

I was DX with AFib a year ago but with a cardioversion got back into regular sinus rhythm for several months. Unfortunately blood thinner eliquis caused a lot of bleeding including rectal. I was actually put in hospital for colonoscopy instead of regular clinic. I went off eliquis as directed, has what they called a “double prep” which did cause dehydration and at time of colonoscopy went back into AFib. Since then, back and forth w AFib , SVT. I think i May have to have ablation. Back to cardiologist end of July ( or before if I’m not able to manage the AFib episodes in a low enough heart rate). Blood thinner still causing bleeding but not so much. I just feel scared all the time, which is of course the worst thing for me. I pray, meditate, journal, etc - all the stress reducers recommended but I can’t get that under control while there are several other very complicating family issues going on. Thanks for opportunity to sound off here!

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@jenrev

AJ, I'll reply because I am an arrhythmia patient myself, no pacemaker but 5 ablations and rhythm control with Amiodarone for periodic a-fib and PVCs. I just had a colonoscopy two weeks ago and my gastro dr. and I briefly discussed the chance for arrhythmias to arise during or after the procedure. It so happened that I had a run of PVCs going the morning of the procedure, and still had them later that day, but that was my normal pattern. There were NO changes caused by the procedure.

If you are on blood thinning medication, check with your cardiologist/EP to find out whether it's okay to hold off that medication for a few days before the procedure, which is what the gastroenterologist requires. I was okay to hold Eliquis for 5 days before the procedure, and resume it immediately afterward.

It's good that you are inquiring and following up with your physicians. I am sure you will be just fine.

Jennifer

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Eliquis has a clearance half-life of about 6 hours, the apparent half-life during repeat dosing is about 12 hours, which allows twice-daily dosing to provide effective anticoagulation, but it also means that when the drug is stopped for surgery, anticoagulation persists for at least a day. So why do docs for for 3 days or longer?

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@harveywj

Eliquis has a clearance half-life of about 6 hours, the apparent half-life during repeat dosing is about 12 hours, which allows twice-daily dosing to provide effective anticoagulation, but it also means that when the drug is stopped for surgery, anticoagulation persists for at least a day. So why do docs for for 3 days or longer?

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The elimination half-life of Apixaban is approximately 12 hours (8-15 hour range). The full clearance is approximately 5.5 times that, or 3.5 days, during which time excessive bleeding is likely. I’ve stopped it 5 days in advance of prostate surgery and I still bled profusely.

The bigger issue is stopping the bleeding once it occurs as the reversal agents for Eliquis aren’t readily available.

Apixaban - https://www.ncbi.nlm.nih.gov/books/NBK507910/

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@fortunateoldguy

The elimination half-life of Apixaban is approximately 12 hours (8-15 hour range). The full clearance is approximately 5.5 times that, or 3.5 days, during which time excessive bleeding is likely. I’ve stopped it 5 days in advance of prostate surgery and I still bled profusely.

The bigger issue is stopping the bleeding once it occurs as the reversal agents for Eliquis aren’t readily available.

Apixaban - https://www.ncbi.nlm.nih.gov/books/NBK507910/

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Prostate surgery is a very bloody surgery. You blame eliquis for for bleeding profusely? I was diagnosed with PCa 23 years ago and have known many who bleed profusely.
From the article you link they recommend 48 hours for high risk surgery.
"The elimination half-life is about 12 hours (8 to 15 hours). Before a patient undergoes elective surgery or an invasive procedure, the drug should be held for 48 hours if the procedure is a moderate-high risk with clinically significant bleeding".
You say "The bigger issue is stopping the bleeding once it occurs as the reversal agents for Eliquis aren’t readily available."
If you had that kind of bleeding I assume you were in a hospital which is the only facilities to have it in stock.
"Andexanet alfa is a recombinant modified factor Xa protein approved by the FDA in May 2018 to reverse apixaban and rivaroxaban in patients with life-threatening or uncontrolled bleeding".

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hi, my mother developed AFIB right after waking up from her colonoscopy. She has had no previous heart problems/conditions before this but has has occasional low blood pressure. In the ER, they were able to reverse the AFIB and everything seems fine now. In the ER they also said her electrolytes were fine.

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