How to manage gum bleeding on Xarelto (rivaroxaban)?

From the Guidelines

If you experience gum bleeding while taking Xarelto (rivaroxaban), apply firm pressure to the bleeding area with a clean gauze or cloth for 15-20 minutes, as there is no evidence to support the use of topical amniotic acid for this indication. The management of bleeding in patients on oral anticoagulants, such as Xarelto, is guided by expert consensus decision pathways, which prioritize measures to promote hemostasis and minimize the risk of thromboembolic events 1.

When managing gum bleeding on Xarelto, it is essential to consider the following steps:

• Apply firm pressure to the bleeding area with a clean gauze or cloth for 15-20 minutes
• Rinse your mouth gently with cold water or ice water to constrict blood vessels and promote clotting
• Avoid hot foods, alcohol, smoking, and vigorous tooth brushing or flossing for 24 hours after bleeding stops
• Use a soft-bristled toothbrush and maintain good oral hygiene with gentle brushing twice daily

For persistent or severe bleeding, it is crucial to contact your healthcare provider immediately, as dose adjustment or temporary discontinuation of Xarelto may be necessary, and reversal agents such as andexanet alfa may be considered in specific situations, as outlined in the 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants 1. Regular dental check-ups are also important while on anticoagulant therapy to monitor oral health and prevent complications.

From the Research

Management of Gum Bleeding on Xarelto (Rivaroxaban)

To manage gum bleeding on Xarelto (rivaroxaban), several approaches can be considered:

• Topical application of tranexamic acid (TXA) has been shown to be effective in achieving hemostasis in patients on direct oral anticoagulants (DOACs) 2.
• The use of TXA is simple, cost-effective, and requires minimal resources, making it a viable option for emergency departments 2.
• In cases of severe bleeding, replacement of blood components, including red blood cells, platelets, and clotting factors, may be necessary, along with reversal of the anticoagulated state 3.
• For patients treated with factor Xa inhibitors like rivaroxaban, andexanet alfa can be used to reverse the anticoagulant effect in cases of major bleeding 3.

Considerations for Dental Patient Management

When managing dental patients on Xarelto (rivaroxaban), it is essential to consider the following:

• The risk of bleeding and the need for effective hemostasis 4.
• The use of topical hemostatic agents, such as TXA, may be beneficial in controlling bleeding 2.
• The controversy surrounding the stoppage of antiplatelet and anticoagulant medications prior to dental procedures should be taken into account, and the decision to stop or continue these medications should be made on a case-by-case basis 5.

Treatment of Severe Bleeding

In cases of severe bleeding, the following steps can be taken:

• Replacement of lost blood components, including red blood cells, platelets, and clotting factors 3.
• Reversal of the anticoagulated state using specific agents, such as andexanet alfa for factor Xa inhibitors 3.
• Use of topical hemostatic agents, such as TXA, to achieve hemostasis 2.