Should vericiguat (Verquvo) be stopped before dental work?

Management of Vericiguat (Verquvo) for Dental Procedures

Vericiguat can be continued during minor dental procedures without interruption, as the bleeding risk is low and can be managed with local hemostatic measures.

Understanding Vericiguat and Dental Procedures

Vericiguat is a soluble guanylate cyclase stimulator with a half-life of approximately 20 hours in healthy volunteers and 30 hours in patients with heart failure with reduced ejection fraction (HFrEF) 1. Unlike traditional anticoagulants, vericiguat does not directly affect the coagulation cascade, making its bleeding risk profile different from medications like warfarin or direct oral anticoagulants (DOACs).

Risk Assessment for Dental Procedures

• Dental procedures are generally considered low bleeding risk procedures 2
• Minor dental procedures such as tooth extractions and endodontic (root canal) procedures can typically be performed safely without interruption of antithrombotic therapy 2
• Local hemostatic measures are usually sufficient to control bleeding during and after dental procedures 2

Evidence-Based Approach

Guidance from Anticoagulant Management

While specific guidelines for vericiguat in dental procedures are not available, we can extrapolate from recommendations for other cardiovascular medications:

• For patients on vitamin K antagonists (VKAs), guidelines suggest continuing therapy with coadministration of an oral prohemostatic agent or stopping VKAs only 2-3 days before the procedure 2
• For patients on antiplatelet therapy for secondary prevention of cardiovascular disease, continuing therapy during minor dental procedures is recommended 2
• Even for direct oral anticoagulants (DOACs), which have more direct effects on coagulation than vericiguat, minor dental procedures can often be performed without interruption 2

Vericiguat-Specific Considerations

• Vericiguat works by enhancing the cyclic guanosine monophosphate pathway, not by directly affecting coagulation 1, 3
• Its mechanism of action primarily involves vasodilation rather than anticoagulation 1
• Studies have shown that vericiguat has a favorable safety profile, with symptomatic hypotension occurring in only 13.5% of patients in real-world settings 4

Practical Management Recommendations

• Continue vericiguat during minor dental procedures 2
• Inform the dentist about all medications being taken, including vericiguat 2
• Consider the following local hemostatic measures during dental procedures:
  • Use of absorbable gelatin sponge and sutures 2
  • Application of local pressure after the procedure 2
  • Consider tranexamic acid mouthwash (5 mL oral dose, 5-10 minutes before the procedure and 3-4 times daily for 1-2 days after) if additional hemostatic support is needed 2

Special Considerations

• For extensive oral surgery or procedures with higher bleeding risk, consider consulting with the patient's cardiologist 2
• Patients with additional risk factors for bleeding may require individualized approaches 2
• If the patient is also taking other antithrombotic medications (like aspirin or anticoagulants), the combined risk should be evaluated 2

Common Pitfalls to Avoid

• Unnecessarily stopping vericiguat before minor dental procedures, which could increase cardiovascular risk 2
• Failing to communicate with the dental provider about the medication regimen 2
• Not implementing adequate local hemostatic measures during and after the procedure 2