Management of Eliquis (Apixaban) for Dental Procedures
For most dental procedures, you should NOT stop Eliquis—continue the medication and use local hemostatic measures instead. 1
Risk Stratification Approach
Minimal to Low Bleeding Risk Procedures (Most Dental Work)
Continue Eliquis without interruption for the following procedures 2, 1:
- Simple extractions (1-3 teeth)
- Dental cleanings and scaling
- Simple fillings
- Root canals
- Crown preparations
- Minor periodontal procedures
Key management strategies:
- Use local hemostatic measures such as absorbable gelatin sponge, sutures, and tranexamic acid mouthwash at extraction sites 1, 3
- No well-documented cases of clinically significant bleeding exist after dental procedures in patients on DOACs when appropriate local hemostatic measures are used 1
- For twice-daily dosing, consider timing the procedure 12 hours after the last dose and resume that evening if hemostasis is adequate 1
High Bleeding Risk Dental Procedures (Rare)
If the procedure carries very high bleeding risk (extensive oral surgery, multiple extractions >3 teeth), consider brief interruption 2:
Interruption protocol for apixaban:
- Stop 2 days (48 hours) before the procedure for high bleeding risk 2
- Stop 3 days (72 hours) before if patient has renal impairment (CrCl <30 mL/min) 2
- Resume 6+ hours after procedure once adequate hemostasis is achieved 2
Critical Considerations
Do NOT use heparin bridging 2:
- Bridging anticoagulation increases hemorrhagic risk without reducing thrombotic risk 2
- This practice is no longer recommended routinely 2
Assess patient-specific factors 1:
- Renal impairment (requires longer interruption time)
- Advanced age
- Concomitant medications that increase bleeding risk (NSAIDs, other antiplatelet agents)
- History of bleeding complications
Coordinate with prescribing physician only if 1:
- Very high bleeding risk procedure planned
- Patient has multiple risk factors for bleeding
- Recent thrombotic event (consider delaying elective procedure) 2
Common Pitfalls to Avoid
- Do not routinely stop Eliquis for standard dental work—this increases stroke risk unnecessarily without meaningful bleeding risk reduction 1, 3
- Do not measure drug levels or coagulation parameters routinely—these are not validated for predicting bleeding risk in dental procedures 2
- Do not use bridging anticoagulation—this significantly increases bleeding complications 2
- Do not fail to use local hemostatic measures—these are highly effective and make interruption unnecessary in most cases 1, 3