Does Eliquis (apixaban) need to be stopped prior to dental cleaning?

Eliquis Does NOT Need to Be Stopped for Routine Dental Cleaning

For routine dental cleaning (prophylaxis), Eliquis (apixaban) should be continued without interruption. Dental cleanings are classified as low hemorrhagic risk procedures where adequate local hemostasis can be achieved, and the thrombotic risk of stopping anticoagulation outweighs the minimal bleeding risk 1.

Risk Classification of Dental Cleaning

• Routine dental cleaning is categorized as a low hemorrhagic risk procedure where bleeding can be easily controlled with local measures 1.
• The French Working Group on Perioperative Hemostasis specifically classifies procedures with low bleeding risk as those where local hemostatic measures are sufficient and do not require anticoagulation interruption 1.
• The American College of Chest Physicians guidelines for dental procedures suggest that minor dental work, including cleanings, can be safely performed on anticoagulation 1.

Management Protocol for Low-Risk Dental Procedures

Continue Eliquis without interruption for routine dental cleaning 1. The protocol for low hemorrhagic risk procedures explicitly states:

• No preoperative interruption of direct oral anticoagulants (DOACs) like apixaban is needed 1.
• No bridging anticoagulation is required since the medication is not being stopped 1.
• Local hemostatic measures (pressure, hemostatic agents, sutures if needed) are sufficient to control any bleeding 1.

When Eliquis WOULD Need to Be Stopped

For context, apixaban interruption is only necessary for high hemorrhagic risk dental procedures 1:

• Complex extractions, multiple extractions, or surgical extractions requiring extensive tissue manipulation 1.
• Dental implant placement 1.
• Periodontal surgery with extensive flap elevation 1.

For these high-risk procedures, the FDA label recommends stopping apixaban at least 48 hours before the procedure for patients with normal renal function 2.

Critical Pitfalls to Avoid

• Never stop Eliquis for routine dental cleaning - this unnecessarily increases stroke/thrombotic risk without meaningful reduction in bleeding risk 1, 2.
• Do not confuse dental cleaning with dental surgery - cleanings are fundamentally different from extractions or surgical procedures 1.
• Avoid unnecessary bridging - if Eliquis were stopped (which it shouldn't be for cleaning), bridging with heparin or LMWH dramatically increases bleeding risk without reducing thrombotic risk 1.
• Communicate with the dentist - ensure they understand the patient is anticoagulated and may need extra attention to local hemostasis, but this does not require stopping the medication 2.

Local Hemostatic Measures

The dentist should be prepared to use standard local measures if needed 1:

• Direct pressure with gauze
• Topical hemostatic agents (tranexamic acid rinse, gelatin sponges)
• Sutures if necessary for gingival bleeding
• Avoid traumatic cleaning techniques

Patient Counseling

Inform patients that 2:

• They should continue taking Eliquis as prescribed before and after dental cleaning
• Minor gum bleeding during or after cleaning may last slightly longer than usual but is not dangerous
• They should inform the dentist they are taking Eliquis
• They should report any unusual or prolonged bleeding to their dentist or physician