The patient should stop rivaroxaban, a new oral anticoagulant (NOAC), the day before his scheduled colonoscopy. Because polypectomy or biopsy of lesions may become necessary during this patient's colonoscopy, interruption of anticoagulation is suggested in patients who are not at high risk for thromboembolic events, which includes this patient, because his thrombotic event occurred more than 3 months ago. Compared with warfarin, it is not yet known at what residual drug level procedures and surgeries can be safely performed without undue bleeding risk in patients taking an NOAC. In the absence of clinical data about when to stop these drugs before surgery, the half-life of the anticoagulant is the most frequently used parameter to decide when to stop the drug. Reported half-lives are 14 to 17 hours for dabigatran, 7 to 11 hours for rivaroxaban, 8 to 14 hours for apixaban, and 5 to 11 hours for edoxaban. For surgical procedures with standard risk for bleeding, the NOAC should be discontinued 2 to 3 half-lives beforehand, and in procedures with high bleeding risk, 4 to 5 half-lives beforehand. Close attention to kidney function is needed, because kidney impairment leads to prolonged half-lives of the NOACs. In this patient with normal kidney function, stopping rivaroxaban 24 to 36 hours before the procedure would be appropriate.

Bridging with low-molecular-weight heparin (LMWH) is not indicated, because LMWHs have half-lives of 4 to 7 hours, not much shorter than the NOACs. Additionally, this patient is not at high risk for thromboembolism and would not need preprocedural bridging even if he were taking warfarin.