Do patients on Eliquis (apixaban) need to stop taking their medication during dental procedures?

Management of Apixaban (Eliquis) During Dental Procedures

Most dental procedures can be safely performed without interrupting apixaban therapy, as the risk of thromboembolic events from discontinuation outweighs the risk of bleeding complications. 1, 2

Classification of Dental Procedures by Bleeding Risk

Low Bleeding Risk Procedures (No Need to Discontinue Apixaban)

• Routine dental cleaning and examinations 1
• Simple dental fillings 2
• Single tooth extractions 2
• Minor periodontal procedures 1

Higher Bleeding Risk Procedures (Consider Management Strategy)

• Extraction of more than 3 teeth 2
• Crown lengthening 2
• Open-flap surgery 2
• Surgical extractions 2
• Extensive periodontal surgery 2

Management Approach for Patients on Apixaban

For Low Bleeding Risk Procedures:

• Continue apixaban therapy without interruption 1
• Use local hemostatic measures as needed:
  • Absorbable gelatin sponge 3
  • Sutures for extraction sites 3
  • Tranexamic acid mouthwash 1, 4

For Higher Bleeding Risk Procedures:

• For twice daily regimen, consider timing the procedure to occur 12 hours after the last dose 3
• Resume apixaban the evening of the same day if twice daily regimen, assuming adequate hemostasis is achieved 3
• If bleeding risk is very high, consult with the prescribing physician about a potential brief interruption 3

Important Considerations

• Premature discontinuation of apixaban significantly increases thromboembolic risk, which can lead to serious morbidity and mortality 5
• The relative ease with which oral bleeding can be controlled with local measures makes interruption of anticoagulation therapy unnecessary for most dental procedures 3
• There are no well-documented cases of clinically significant bleeding after dental procedures in patients on direct oral anticoagulants when appropriate local hemostatic measures are used 3, 4

Special Situations

• For patients with additional risk factors (renal impairment, advanced age, concomitant medications that increase bleeding risk), consider consulting with the prescribing physician 3
• If the patient is also taking antiplatelet agents (e.g., aspirin), the bleeding risk is increased, but most dental procedures can still be performed safely with appropriate local hemostatic measures 5, 2

Common Pitfalls to Avoid

• Routinely instructing patients to stop "blood thinners" before dental procedures without evaluating the thromboembolic risk 3
• Failing to use adequate local hemostatic measures during and after the procedure 1, 2
• Not informing the dentist about all medications the patient is taking, including over-the-counter products that may affect bleeding 5
• Inadequate post-procedure instructions for managing potential bleeding 2

In conclusion, for most dental procedures, apixaban therapy should be continued without interruption, with appropriate local hemostatic measures employed to manage any bleeding. The risk of thromboembolic events from discontinuation generally outweighs the risk of bleeding complications during dental procedures.