How long should a patient with atrial fibrillation taking Eliquis (apixaban) hold the medication before dental surgery?

How Long to Hold Eliquis for Dental Surgery

For routine dental surgery, hold Eliquis for 24 hours before the procedure—meaning skip the dose the night before and the morning of surgery. 1, 2

Risk Classification of Dental Procedures

Dental surgery is classified as a low bleeding risk procedure because:

• Bleeding frequency is low and can be easily controlled with local hemostatic measures 3, 1
• Most routine dental work including extraction of 1-3 teeth, periodontal surgery, and abscess incision fall into this category 1
• The procedure site allows for adequate local hemostasis 3

Specific Timing for Eliquis Interruption

For patients taking Eliquis 5 mg twice daily:

• Take the last dose on the morning of the day before the dental procedure 1
• This provides approximately 24 hours of interruption 3, 1
• Skip both the evening dose before surgery and the morning dose on the day of surgery 1

The 24-hour interruption applies regardless of kidney function as long as creatinine clearance is >30 mL/min, since apixaban has less renal elimination compared to dabigatran 1

Critical Management Points

What NOT to Do:

• 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 3, 1
• Do not extend the interruption unnecessarily beyond 24 hours for routine dental procedures 3, 1

Local Hemostatic Measures:

• Use local hemostatic agents such as tranexamic acid-soaked gauze at the surgical site 1
• Ensure proper surgical technique and adequate local hemostasis 3

Resuming Eliquis After Dental Surgery

Restart Eliquis as early as 6 hours after the dental procedure once adequate hemostasis is established 1

• Most patients can safely resume their regular dosing schedule the evening of the procedure or the next morning 1
• Ensure bleeding has stopped and the surgical site is stable before restarting 1

Comparison with FDA Labeling

The FDA label for apixaban states that the drug should be discontinued at least 24 hours prior to elective surgery or invasive procedures with a low risk of bleeding 2, which aligns perfectly with the guideline recommendations for dental surgery.

Special Considerations

For patients on Eliquis 2.5 mg twice daily (reduced dose regimen):

• The same 24-hour interruption applies 1
• Take the last dose on the morning before the procedure 1

Renal function considerations:

• If creatinine clearance is 30-50 mL/min, the 24-hour interruption remains appropriate for dental procedures 3
• Only dabigatran requires extended interruption based on renal function; apixaban timing is consistent 3, 1