How many days before a dental procedure should a person stop taking Eliquis (apixaban)?

Eliquis Management Before Dental Procedures

For most dental procedures, stop Eliquis (apixaban) 24 hours before the procedure if it is low bleeding risk, or 48 hours (2 days) before if it is moderate-to-high bleeding risk. 1

Risk Stratification is Critical

The duration of Eliquis interruption depends entirely on the bleeding risk of the specific dental procedure:

Low Bleeding Risk Dental Procedures

• Stop Eliquis 24 hours before the procedure 1
• Low-risk procedures include: routine cleanings, simple restorations, single tooth extractions, and periodontal probing 2, 3
• Many contemporary guidelines actually support continuing anticoagulation for most routine dental work with local hemostatic measures (gauze, tranexamic acid, sutures) 3, 4

Moderate-to-High Bleeding Risk Dental Procedures

• Stop Eliquis 48 hours (2 days) before the procedure 1
• High-risk procedures include: multiple extractions, surgical extractions, dental implant placement, extensive periodontal surgery, and procedures where hemostasis cannot be easily controlled 5

Special Considerations Based on Renal Function

For patients with creatinine clearance >30 mL/min, the standard 2-3 day interruption applies for high-risk procedures 5

• The French perioperative guidelines recommend stopping apixaban 3 days (72 hours) before high hemorrhagic risk procedures when CrCl >30 mL/min 5
• Unlike dabigatran, apixaban does not require extended interruption periods for renal impairment since it has less renal elimination 5

Critical Pitfalls to Avoid

• Never use bridging anticoagulation with heparin products when stopping Eliquis for dental procedures - this dramatically increases bleeding risk without reducing thrombotic risk 2, 3
• Do not perform neuraxial blocks or deep nerve blocks if there is any possibility of residual Eliquis levels, particularly in elderly patients (>80 years) or those with renal impairment 5
• Verify recent creatinine clearance before determining the interruption window, as this affects drug elimination 5
• Check for P-glycoprotein inhibitors or CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) which increase apixaban levels and may require longer interruption 5, 1

Resumption After the Procedure

• Resume Eliquis at least 6 hours after the procedure if hemostasis is adequate and there is no ongoing bleeding 2, 1
• For twice-daily dosing, resume the evening of the procedure day 5
• If bleeding persists or hemostasis is inadequate, delay resumption for 24-48 hours and consider prophylactic LMWH for thromboembolism prevention 5

The Contemporary Evidence Debate

There is growing evidence that most routine dental procedures can be performed safely without stopping anticoagulation at all 3, 4:

• A systematic review found that continuing anticoagulation during dental procedures did not increase bleeding risk in most trials when local hemostatic measures were used 3
• Research on dental implant surgery showed no significant bleeding differences between patients continuing rivaroxaban (a similar DOAC) versus controls 6
• Single and multiple extractions can be safely performed with continued antiplatelet/anticoagulant therapy using local hemostasis (gelatin sponge, tranexamic acid gauze, sutures) 7, 4

However, the FDA label and formal guidelines still recommend interruption for moderate-to-high risk procedures, so the safest medicolegal approach is to follow the 24-48 hour interruption protocol based on bleeding risk 1, 2