Periendoscopic management of DOACs according to BSG/ESGE guidelines
| Low-risk procedures | High-risk procedures | |||
| Timing of last dose before endoscopy | Timing of first dose after endoscopy | Timing of last dose before endoscopy | Timing of first dose after endoscopy | |
| Dabigatran etexilate (CrCl* >50 mL/min) | Evening of day −1 | Evening of day of procedure | Morning of day −2 or evening of day −3 | Day +2† |
| Dabigatran etexilate (CrCl 30–50 mL/min) | Evening of day −1 | Evening of day of procedure | Morning of day −3 or evening of day −4 | Day +2† |
| Apixaban | Evening of day −1 | Evening of day of procedure | Morning of day −2 or evening of day −3 | Day +2† |
| Rivaroxaban | Day −1 | Same day of procedure | Day −3 | Day +2† |
| Edoxaban | Day −1 | Same day of procedure | Day −3 | Day +2† |
↵*CrCl=creatinine clearance, calculated by Cockcroft-Gault equation.
↵†Day+3 for procedure at very high risk of bleeding (large EMR, ESD), at endoscopist’s discretion.
BSG, British Society of Gastroenterology; DOACs, direct oral anticoagulants; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; ESGE, European Society of Gastrointestinal Endoscopy.