When should Eliquis (apixaban) be held for a dental filling procedure?

Management of Eliquis (Apixaban) for Dental Filling Procedures

You do not need to hold Eliquis (apixaban) for routine dental filling procedures. Dental fillings are classified as minimal-bleed-risk procedures that can be safely performed while continuing anticoagulation. 1

Procedure Classification and Management

Dental fillings fall into the minimal-bleed-risk category (30-day risk of major bleeding approximately 0%), which includes minor dental procedures such as dental extractions, restorations, prosthetics, endodontics, dental cleanings, and fillings. 1

For Standard Dental Fillings:

• Continue apixaban without interruption 1
• The procedure can be performed at trough levels (12-24 hours after last dose) 1
• No bridging anticoagulation is needed 1, 2
• Adequate local hemostasis measures should be available 1

Practical Timing Approach:

If you prefer to minimize peak anticoagulant effects during the procedure:

• Schedule the appointment 18-24 hours after the last apixaban dose (essentially at trough level before the next scheduled dose) 1
• Resume the regular twice-daily dosing schedule immediately after the procedure 2
• This approach involves skipping only one dose at most 1

When to Consider Holding Apixaban

For higher bleeding risk dental procedures (such as multiple extractions or complex oral surgery), consider holding apixaban:

• Discontinue 48 hours (2 days) before the procedure in patients with normal renal function (CrCl >50 mL/min) 2, 3
• For patients with CrCl 30-50 mL/min, extend to 72 hours (3 days) 4
• Resume at least 6 hours after the procedure once adequate hemostasis is confirmed 2, 3

Key Evidence Supporting Continuation

The American College of Chest Physicians 2022 guidelines explicitly classify dental fillings as minimal-bleed-risk procedures where anticoagulation interruption is unnecessary. 1 The European Heart Rhythm Association similarly recommends not interrupting oral anticoagulation for minor procedures where bleeding is easily controllable. 1

Common Pitfalls to Avoid

• Do not routinely hold apixaban for simple dental fillings - this increases thromboembolic risk without meaningful bleeding risk reduction 1, 5
• Do not use heparin bridging - this is not recommended and increases bleeding complications 1, 2
• Do not confuse dental fillings with dental extractions - extractions may warrant brief interruption, but fillings do not 1
• Ensure local hemostatic measures are available before proceeding with any dental work 1

The evidence consistently demonstrates that direct oral anticoagulants like apixaban are safe for routine dental procedures, with postoperative bleeding complications manageable with conventional hemostasis measures. 5