Should I hold Eliquis (apixaban) for a dental procedure?

From the Guidelines

You should not stop taking Eliquis (apixaban) for a minor dental procedure, as the risk of bleeding is generally manageable and the benefits of continuing anticoagulation outweigh the risks. The decision to hold or continue Eliquis depends on your specific medical condition, bleeding risk, and the invasiveness of the dental work. For minor dental procedures like simple cleanings or fillings, Eliquis typically does not need to be stopped, as suggested by the American College of Chest Physicians clinical practice guideline 1.

When considering the management of antithrombotic therapy for dental procedures, it's essential to weigh the risks of bleeding against the risks of thromboembolic events. The 2018 European Heart Rhythm Association practical guide recommends not interrupting oral anticoagulation for most minor surgical procedures and those where bleeding is easily controllable 1. However, the most recent and highest quality study, the 2022 American College of Chest Physicians clinical practice guideline, suggests continuing antiplatelet drugs, including those similar to Eliquis, for minor dental procedures 1.

Some key points to consider when making this decision include:

• The type and invasiveness of the dental procedure
• Your individual bleeding risk and medical history
• The timing of the procedure in relation to your last Eliquis dose
• The use of local measures to control bleeding during dental work, such as special mouthwashes, sutures, or hemostatic agents It's crucial to consult with both your prescribing physician and dentist before making any decisions about stopping or continuing Eliquis for a dental procedure, as they can provide personalized guidance based on your specific situation.

From the FDA Drug Label

Apixaban tablets should be discontinued at least 48 hours prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding [see Warnings and Precautions (5. 2)] . Apixaban tablets should be discontinued at least 24 hours prior to elective surgery or invasive procedures with a low risk of bleeding or where the bleeding would be non-critical in location and easily controlled.

The FDA drug label does not provide specific guidance on holding apixaban (Eliquis) for a dental procedure. However, it does provide guidance on discontinuing apixaban for elective surgery or invasive procedures.

• For procedures with a moderate or high risk of bleeding, apixaban should be discontinued at least 48 hours prior to the procedure.
• For procedures with a low risk of bleeding, apixaban should be discontinued at least 24 hours prior to the procedure. It is recommended to consult with a healthcare professional to determine the best course of action for a specific dental procedure 2.

From the Research

Eliquis and Dental Procedures

• Eliquis, also known as apixaban, is a direct oral anticoagulant (DOAC) used to prevent blood clots [ 3 ].
• When it comes to dental procedures, the management of antithrombotic therapy is crucial to balance the risk of bleeding and thromboembolism [ 4, 5, 6, 7 ].

Continuation of Anticoagulation Therapy

• Most studies suggest that continuation of anticoagulation therapy, including Eliquis, is recommended for minor dental procedures, such as simple dental cleaning and filling [ 4, 5, 6, 7 ].
• Local hemostatic measures, such as tranexamic mouthwash, can be used to reduce bleeding events following these interventions [ 4, 5, 6, 7 ].

Decision-Making for Dental Procedures

• The decision to continue or interrupt anticoagulation therapy for more invasive dental procedures should be made on a case-by-case basis, considering factors such as the patient's individual risk of bleeding and thromboembolism [ 4, 5, 6, 7 ].
• A multiphase protocol of surgical approach can be implemented to ensure safety in daily clinical practice [ 6 ].

Education and Collaboration

• Greater education and collaboration among healthcare professionals are essential for navigating the complexities of anticoagulant therapy and ensuring optimal outcomes for patients undergoing dental procedures [ 7 ].