How many days prior to a dental procedure should Eliquis (apixaban) be stopped?

Apixaban (Eliquis) Management Before Dental Procedures

For dental procedures with low bleeding risk, Eliquis (apixaban) should be stopped 24 hours before the procedure, while for procedures with high bleeding risk, it should be discontinued 48 hours prior to the procedure. 1

Risk Assessment and Discontinuation Timeline

Low Bleeding Risk Dental Procedures

• Routine dental cleanings
• Simple extractions
• Minor oral surgery with easily controlled bleeding
• Recommendation: Discontinue apixaban 24 hours before procedure 1
• No bridging anticoagulation is generally required 1

High Bleeding Risk Dental Procedures

• Multiple extractions
• Complex oral surgery
• Procedures with moderate to high risk of significant bleeding
• Recommendation: Discontinue apixaban 48 hours before procedure 1
• Longer discontinuation may be needed in patients with renal impairment 2

Renal Function Considerations

Renal function significantly affects apixaban clearance and should guide discontinuation timing:

Renal Function	CrCl (mL/min)	Recommended Discontinuation Time
Normal	≥50	Standard protocol (24-48h)
Moderate	30-50	Consider extending to 3 days
Severe	15-29.9	Consider extending to 4 days

Special Considerations

Minor Dental Procedures

For very minor dental procedures with minimal bleeding risk (e.g., simple cleaning, single tooth extraction):

• Some guidelines suggest continuing apixaban without interruption with appropriate local hemostatic measures 3
• This approach should be considered only when bleeding risk is very low and can be easily controlled with local measures

Post-Procedure Management

• Resume apixaban as soon as adequate hemostasis is established 1
• For low bleeding risk procedures: typically resume 24 hours after procedure
• For high bleeding risk procedures: typically resume 48-72 hours after procedure
• Use local hemostatic measures as needed (gelatin sponge, suturing) 4

Important Caveats

• No routine laboratory monitoring of apixaban is required when following these discontinuation protocols
• Unlike vitamin K antagonists (e.g., warfarin), bridging with heparin is generally not necessary when interrupting apixaban 1
• The risk of thromboembolism during brief interruption of apixaban for dental procedures is generally low
• For patients at extremely high thrombotic risk, consult with the prescribing physician before interrupting therapy

Practical Algorithm

1. Assess bleeding risk of the dental procedure
2. Evaluate patient's renal function
3. For low bleeding risk: stop apixaban 24 hours before procedure
4. For high bleeding risk: stop apixaban 48 hours before procedure
5. Extend discontinuation time for impaired renal function
6. Resume apixaban once adequate hemostasis is achieved

This approach balances the risk of bleeding complications against the risk of thrombotic events during the perioperative period.