What is the recommended duration to discontinue Eliquis (apixaban) prior to a dental procedure?

From the Guidelines

For patients taking Eliquis (apixaban) who are undergoing a dental procedure, it is generally recommended to stop the medication 24-48 hours beforehand for procedures with a higher risk of bleeding, such as multiple extractions or extensive gum surgery, based on the most recent and highest quality study 1. The decision to stop Eliquis before a dental procedure depends on the specific bleeding risk and the invasiveness of the procedure.

• For low-to-moderate-bleed-risk procedures, withholding Eliquis for 1 full day (approximately 24 hours) before the procedure may be sufficient, as this allows for approximately three half-lives of the drug to pass, resulting in a residual anticoagulant effect that is acceptable clinically for lower bleed risk procedures 1.
• For high-bleed-risk procedures, withholding Eliquis for 2 full days (approximately 48 hours) before the procedure may be necessary, as this allows for approximately four to five half-lives of the drug to pass, resulting in minimal to no residual anticoagulant effect at the time of surgery 1. It is essential to consult with both the dentist and the healthcare provider who prescribed Eliquis before making any changes to the medication regimen, as they may recommend different timing based on individual circumstances, including the reason for taking Eliquis, kidney function, and other medications being taken. After the dental procedure, Eliquis can typically be resumed once adequate hemostasis (bleeding control) has been achieved, usually within 24 hours, to balance the risk of bleeding during the procedure against the risk of thrombotic events from stopping the anticoagulant.

From the FDA Drug Label

Apixaban tablets should be discontinued at least 48 hours prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding [see Warnings and Precautions (5. 2)] . Apixaban tablets should be discontinued at least 24 hours prior to elective surgery or invasive procedures with a low risk of bleeding or where the bleeding would be non-critical in location and easily controlled.

The recommended duration to stop Eliquis (apixaban) prior to a dental procedure depends on the bleeding risk associated with the procedure.

• For procedures with a moderate or high risk of bleeding, stop Eliquis at least 48 hours prior to the procedure.
• For procedures with a low risk of bleeding, stop Eliquis at least 24 hours prior to the procedure 2.

From the Research

Stopping Eliquis Prior to Dental Procedure

• The studies provided do not specify the exact duration for which Eliquis (apixaban) should be stopped prior to a dental procedure 3, 4, 5.
• However, it is mentioned that apixaban has a short half-life, which could be an advantage in managing patients on anticoagulation therapy 4.
• The use of local hemostatic agents, such as tranexamic acid, can be considered as an alternative to modifying or discontinuing anticoagulant regimens 6, 7.
• Tranexamic acid mouthrinse has been shown to be effective in controlling bleeding in patients on antiplatelet therapy with a therapeutic International Normalized Ratio (INR) level 7.
• It is essential for dentists to have a sound understanding of the mechanisms of action and management guidelines for patients taking new oral anticoagulants, including apixaban 4, 5.