Do you continue antiplatelet/anticoagulant therapy in patients with hemodynamically stable diverticular bleeding to improve localization and treatment of source of bleeding?

Usually the decision to stop antiplatelet/anticoagulant therapy is dependent on the indication for starting the therapy, the severity of the bleeding and hemodynamic status of the patient. Based on the current ACG guidelines, it is ok to continue antiplatelet/anticoagulant therapy for hemodynamically stable pts ( esp if INR is < 2.5). Non-urgent colonoscopy with non-thermal treatment can be done for these pts while on these therapies.

Provocative heparin infusion during angiography is used for recurrent GI bleeding if the source cannot be found and there are studies which suggest that it can improve yields in endoscopy as well. Based on these, it can be extrapolated that continuing these agents may help in localization (or at least showing ...

Agree with the above. In community practice, most cases are admitted after the discontinuation of antiplatelets and anticoagulants are discontinued from ER itself, as they have frank rectal bleeding.

The CTA and RBC tag scan are performed in 6-12 hours and are usually negative, while the patient continues to have maroon stool with a slow drop in hemoglobin. GI is consulted for a colonoscopy.

Bowel prep one day, so the colonoscopy is performed on the second day after admission, and you don't find anything except blood-stained diverticula.

Is it worthwhile to start a heparin drip 1-2 hours prior to the colonoscopy to induce bleeding in them, or just wait for a second admission to tackle the issue?

IV heparin prior to endoscopy is an interesting option but in most instances anti platelet and DAPT is held, especially since this halts bleeding and most diverticular bleeds are infrequent.