Management of Anticoagulation for Dental Procedures

Risk Stratification and Management

For procedures with moderate to high bleeding risk, hold apixaban for 48 hours before the procedure, as recommended by the American College of Cardiology and supported by the French Working Group on Perioperative Hemostasis 1
The French Working Group on Perioperative Hemostasis recommends a minimum 3-day interruption for high hemorrhagic risk procedures when creatinine clearance is >30 mL/min, with a strength of evidence based on multiple systematic reviews and clinical trials 2, 3, 4

Last dose timing for twice-daily regimen: Take the morning dose on the day before the procedure (24-hour hold) for low-risk procedures, as suggested by the American Heart Association 1
Resume apixaban at least 6 hours after the procedure once adequate hemostasis is achieved, with a return to the regular twice-daily dosing schedule, as recommended by the American College of Cardiology 1

No bridging with heparin is needed for dental procedures, as this increases bleeding risk without reducing thrombotic events, according to the American College of Chest Physicians and the French Working Group on Perioperative Hemostasis 1, 2
Check renal function if not recently assessed, as this affects drug clearance, with a strength of evidence based on clinical trials and systematic reviews 2, 3