Should vericiguat be stopped before a dental procedure?

Management of Vericiguat for Dental Procedures

Vericiguat does not need to be stopped before dental procedures. This recommendation aligns with guidelines for other cardiovascular medications during dental procedures, where continuing therapy is generally preferred to minimize cardiovascular risks.

General Approach to Anticoagulants and Antiplatelets for Dental Procedures

• For patients requiring minor dental procedures, the American College of Chest Physicians recommends continuing vitamin K antagonists (VKAs) with co-administration of an oral prohemostatic agent or stopping VKAs only 2-3 days before the procedure rather than complete interruption 1
• For patients on antiplatelet therapy (such as ASA) who are having minor dental procedures, continuing therapy around the time of the procedure is recommended rather than stopping 7-10 days before 1
• The risk of dental procedure-related bleeding is generally low, particularly with single tooth extractions, and most bleeding can be managed with local measures 1

Specific Considerations for Vericiguat

• Vericiguat is a soluble guanylate cyclase stimulator that enhances the cyclic guanosine monophosphate pathway, with a half-life of approximately 30 hours in patients with heart failure with reduced ejection fraction (HFrEF) 2
• Unlike anticoagulants or antiplatelets, vericiguat does not directly affect coagulation pathways or platelet function, making bleeding concerns minimal 2
• Vericiguat's pharmacodynamic effects are primarily related to smooth muscle relaxation in the vasculature leading to hemodynamic changes, not bleeding risk 2

Management Recommendations

• Continue vericiguat during dental procedures as there is no evidence suggesting increased bleeding risk with this medication 2
• Use local hemostatic measures as needed for any dental bleeding:
  • Apply direct pressure using gauze or cotton to control bleeding 3
  • Consider using tranexamic acid mouthwash (5-10 mL of a 5% solution) before dental procedures and 3-4 times daily for 1-2 days afterward for additional hemostatic support 3

Important Considerations

• The risk of interrupting cardiovascular medications generally outweighs the risk of bleeding during dental procedures 4
• Studies have shown that serious embolic complications from interrupting anticoagulation therapy are three times more likely to occur than bleeding complications in patients whose therapy was continued 4
• For dental extractions specifically, local hemostatic measures are typically sufficient to control bleeding even in patients continuing cardiovascular medications 1, 3

Special Situations

• For patients on vericiguat who also take anticoagulants or antiplatelet medications, follow the specific guidelines for those medications while continuing vericiguat 1
• If the dental procedure is extensive or involves multiple extractions, consult with the patient's cardiologist, but vericiguat itself would not typically need to be discontinued 1

Remember that maintaining cardiovascular medication therapy during dental procedures is generally safer than interruption, as the risk of cardiovascular events from medication discontinuation typically outweighs the risk of procedural bleeding 4.