How Long to Hold Eliquis Before a Dental Procedure
For most dental procedures, hold Eliquis for 24 hours before the procedure (skip 1-2 doses depending on your dosing schedule), as dental work is classified as low bleeding risk. 1, 2
Risk Classification of Dental Procedures
Most routine dental procedures are considered low bleeding risk interventions, including: 1
- Extraction of 1-3 teeth
- Periodontal surgery
- Abscess incision
- Implant positioning
- Dental fillings and cleanings
Specific Timing Based on Dosing Schedule
For Eliquis 5 mg twice daily (standard AF dosing): 1
- Take the last dose on the morning of the day before the procedure
- This provides approximately 24 hours of interruption
- The procedure occurs on Day 0, with last dose on Day -1 morning
For patients on once-daily dosing regimens: 1
- If taking morning doses: last dose on the morning of Day -1
- If taking evening doses: last dose two days before (Day -2 evening)
Key Differences from Other Procedures
Unlike high bleeding risk surgeries that require 48 hours of interruption, dental procedures only need 24 hours because: 1, 2
- Adequate local hemostasis can be achieved
- Bleeding frequency is low
- Clinical impact of bleeding is minor
The 2018 European Heart Rhythm Association guidelines specifically state that dental surgery can be performed safely with minimal interruption and local hemostatic measures. 1
Critical Management Points
Do NOT use bridging anticoagulation with heparin or low-molecular-weight heparin when stopping Eliquis for dental work—this significantly increases bleeding risk without reducing thrombotic risk. 1, 2
Renal function considerations: Unlike dabigatran, apixaban timing remains the same (24 hours) regardless of kidney function as long as creatinine clearance is >30 mL/min, due to less renal elimination. 2
Resuming Eliquis: Restart as early as 6 hours after the dental procedure once adequate hemostasis is established. 2 For standard twice-daily dosing, this typically means resuming the evening of the procedure or the next morning. 1
Alternative Approach: Continue Eliquis
Some guidelines suggest an alternative strategy of continuing anticoagulation with local hemostatic measures for minor dental procedures. 1 The 2012 ACCP guidelines recommend either continuing vitamin K antagonists with oral prohemostatic agents OR stopping 2-3 days before for dental procedures. 1
However, the more recent 2017-2018 guidelines for direct oral anticoagulants like Eliquis favor the 24-hour interruption approach as the primary recommendation. 1, 2
Common Pitfalls to Avoid
Never perform the procedure if uncertain about timing: Ensure you know the exact date and time of the last Eliquis dose. 1 Patients should receive written instructions indicating when to take their last dose.
Avoid NSAIDs perioperatively: These increase bleeding risk when combined with anticoagulation. 1
Don't extend interruption unnecessarily: Holding Eliquis longer than 24 hours for routine dental work increases thrombotic risk without additional bleeding benefit. 1, 2