Arrhythmia and Prep for Colonoscopy

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!

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?

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/

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".

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.

I took a colonoscopy prep and woke up with heart palpitations. I have had no history of a heart condition. I had no idea this could be one of the side effects. I went to the ER to be monitored

I want to xlarify I could not go through with the entire colonoscopy prep nor the colonoscopy because of it

I realize this is 4 years down the road from 2022, but I just wanted to include my experience here for anyone who taps into this blog. I am in my 70's. I went in for a scheduled colonoscopy 4 years ago and as I lay in the prep area they hooked me up to the EKG and the nurse seemed shocked because I was in full A-Fib mode. I had never been diagnosed and at the time I didn't even know what A-Fib was. They cancelled the procedure and sent me to the ER. I had to go on Equis and Metoprolol for 30 days before they would do anything about it and I was in A-Fib the whole time (I monitored myself with Kardia). I then went in for my first Cardioversion which stopped the A-Fib. I never got an affirmative answer from either Cardio or Gastro that it was the colonoscopy prep that caused the A-Fib, they insisted I must have already had it and that they had done thousands of procedures and this did not cause A-Fib. I still needed the colonoscopy (I have UC and need to monitor it) and rescheduled after getting my Gastro Doc to agree to a Sigmoidoscopy instead, Fleet enema prep this time. Everything went well with no A-Fib, however he found polyps and one that was large enough that he couldn't remove it during the procedure. I reluctantly scheduled another colonoscopy to remove the polyp. He would not back down from doing the same prep that I had before. I went through the procedure and went into A-Fib again but he went ahead and operated. I had to have another Cardioversion which they did just a few days later because I was already on the blood thinner now. They did do a Cat scan to make sure that no clot had formed. I had been checking myself on Kardia before this and there had been no sign of A-Fib until prepping for the colonoscopy. Again, they claimed this was a rare occurrence. A short internet search told me differently, that it was quite common. Anyway, this year I was scheduled for another colonoscopy to monitor. I switched doctors and even though he said exactly the same thing, he agreed that I could use a Miralax prep which is over the counter and known to be better tolerated. It was simple and straight forward, and apparently worked quite well. My UC is in complete remission and no A-Fib! To this day I have had no A-Fib other than the 2 colonoscopy prep episodes. Hope this helps anyone out there who has this kind of experience. I recommend the Miralax prep over any prescribed prep just because it's not bad tasting (just mix with Gatorade), and less volume you have to drink, just plenty of fluids on your liquid diet day.

@jenrev I have persistent afib and hypertrophic cardiomyopathy. I had a hip replacement February 2025. I had to go off my blood thinners 3 days prior the surgery. I started the blood thinners post op. 20 hours after the surgery I had a stroke, I was hospitalized for several weeks, I had weakness on my left side and loss of speech for 5 days. Returned home with home care and physio. I was very fortunate and fast action helped me have a good recovery.

I’m scheduled for a repeat colonoscopy (family history and polyp removal last colonoscopy). I am not interested in going of my blood thinners again. I meet with the specialist in a few weeks and would like some suggestion on how this can be done without stopping the blood thinners. I m not wanting a second stroke.
I am a 75 year old female, active and exercise regularly.
I live in Canada. The only cost we incurred was parking at the hospital. All my health care was covered. I did not have to wait for emergency care. I did have a 6 month wait for the hip surgery.

I had one isolated episode of afib in 2015. I was caridoverted in the ED, went on eliquis for a year, and I thought it was in my past. I always told new drs about it, etc. I had left hip replacement in 11/24 with no issues. Then I had right hip replacement 2/26 and I went into afib in recovery. I then coded and had to have compressions to be resuscitated. I was kept in the hospital for 5 days and got out of afib on my own. I am due to meet with a new EP cardiologist next month. One item on the agenda is a necessary colonoscopy and how to prep without triggering afib, so reading your post was very timely. Thanks for sharing,