Anticoagulation Maintenance

Maintaining anticoagulation may reduce unnecessary suspension for patients who have no intervention during colonoscopy. Direct oral anticoagulant users in the maintenance arm omit only the morning dose on colonoscopy day. Vitamin K antagonist users in the maintenance arm continue medication if INR is therapeutic and below 3.5 within 24 hours before the procedure. The protocol treats same-day morning-dose omission for direct oral anticoagulants as pharmacological continuation because therapeutic levels persist. Patients assigned to maintenance continue anticoagulation with handling that differs by drug class.