Dentist and Apixaban

Went for a check up yesterday and she wants to do a de scale and polish.

As I am on Apixaban she would like me to miss two tablets before and one afterwards

Is this the norm?

While I am in the mood for a rabbit. I was on Pradaxa for over a year with no problems and then my GP decided to change me to Apixaban just to give it a try I think.

Seems to be ok the main difference I can see is it does not look as good the packing is cheap by comparison Pradaxa looks a lot more expensive. Have they changed it to save money?

13 Replies

  • I am on Pradaxa. I had a descale and polish at my dental hygienist's on Thursday with no problems. He and the dentist are totally unfazed by my anticoagulation, be it warfarin or dabigatran.

    Like many aged persons I have gum strinkage. This is where the phrase " long in the tooth " comes from. My hygienist and his high pressure jets are firm, but not gentle. I would not be too happy to come off my medication unless it was for something major.

  • Sounds strange to me for only a descale and polish. I've been taking Apixaban for over 2 years and have a descale every 6 months, had 1 filling and a large tooth taken out during that time - never was asked to stop Apixaban by any of the dentists. Bleeding from the extraction was minimal and the dentist said I was his first Apixaban patient. Perhaps query why your dentist thinks you need to miss a full 24 hours' dose.

    I got my new prescription yesterday and I noticed that the packaging was looking rather 'pound shop' too.

    PS just checked the packet and they have also changed the strips from 7 day doses to 10 days.

  • NO, NO, NO.

    It is in the NICE guidelines not to stop any anticoagulation. If on warfarin then an INR of up to 4 is acceptable. That shows you how little risk there is with dental procedures. get then to look up the guidelines. You can always phone the AFA to get the guidance document if you can't find it.

    Even if someone is having a tooth taken out they must NOT stop anticoagulation, even for half a day (eg if taking Apixaban or others that are twice a day). My dentist said on no account should anyone stop any form of anticoagulation for work at the dentists. She stopping was the old policy that some dentists are still stuck into (possibly because they haven't read the up to date information?).

    You increase the RISK of a stroke by stopping anticoagulation, even temporarily.

  • I am not a dentist, nor a doctor, however, despite some howls of protest, we are on medication for a reason. I was told by my doctor that even missing one anti coag session, could be an issue. My dentist also told me she would not do any treatment due to the med mix. Now, I am not saying I agree with them, but only what I was told. I badly require a scale and polish, but my hygienist, (Doktor Death), and I have unpleasant history, so it suits that I play the med card.....

  • Get a different dentist. There is no need for this stupidity. My dentist does any work including extractions on anticoagulants and assures me that this is normal dentistry practice. UP until about three years ago they had a different idea but recent guidelines allow it now. Please don't put yourself at risk for such minor reasons.

  • Thank you all for your replies. Decision made, not stopping. Will tell her to check the current guidelines. I'll find and copy them myself .

  • . The risk of significant bleeding in patients on oral anticoagulants and with a stable INR in the therapeutic range 2-4 (i.e. <4) is very small and the risk of thrombosis may be increased in patients in whom oral anticoagulants are temporarily discontinued. Oral anticoagulants should not be discontinued in the majority of patients requiring out-patient dental surgery including dental extraction (grade A level Ib).

    Found this dated 2011 should have been common knowledge by now.


  • Opps. Not as simple as I thought.

    Looks like I should miss 1 dose of Apixaban

    This is 2015


  • I don't see that recommendation. Treatments with 'no clinically important bleeding risk’ such as extraction of up to 3 teeth can be performed just before the next dose of apixaban. A scale and polish is nowhere near the same level so I think it's an irrelevance.

    What is vital is that you do have a scale & polish and keep your teeth and gums pristine after that. Gum disease is associated with increased risk of AF and strokes. Severe gum disease increases risk of stroke in younger people by 4 times.

  • Like most things there is the matter of interpretation. Being in the older age group I have some receding gums though generally for my age they are good, having always tried to look after them. There is a risk of bleeding when de scaling near the base of the tooth and the more I looked into it, it seems that if you stay taking Apixaban it is better to de scale over several sessions. The ideal is they start and see how it goes. Thanks for your comments Mark

    I will have it done one way or the other.


  • I've had AF for 12months now ,been on Apixaban but never been told to stop-I've had a large filling and descaling every 3months,my Dentist knows my history,I also have Rheumatoid Disease so quite complicated,but I've never had excessive bleeding!

  • My hygienist required a letter from my GP before she would do deep cleaning and scaling of my teeth. Have never had a problem at dentists since starting rivaroxiban, despite having teeth extracted.

  • going for scale and polish Tuesday at practice where my daughter in law is practice manager and the guidelines are to have inr checked no less than 48 hours before so on Monday morning I go for inr check and providing I am within the range treatment will go ahead which makes sense to me .

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