My father-in-law, 92, is on 2.5 x 2 Apixaban/day. He's due to have a tooth removed and the dentist has said he must be off the Apixaban 4 days prior to the extraction. I asked the nurses at the home, where he lives, why 4 days when it has a half-life of just 12 hours! Reply was that the dentist is used to warfarin, so they must do the same to keep the dentist happy 👨⚕️😄.
Just wondering what advice others have had regarding Apixaban and tooth extraction. Four days does seem OTT. And it's not long since he actually had a stroke! So really not keen to have him off it for so long unless it's really necessary.
No experience of tooth extraction, but was due to have a procedure last week that had a high risk of bleeding, so was advised to stop xaltero 24 hours before. They cancelled the procedure , reason they did not want to risk anaesthetic so late with my heart condition ( this was at 5pm)
That is a worrying situation, Koll. I take Apixaban and had a tooth extracted a couple of years ago. I was the first Apixaban patient he had treated and, following his protocol for anticoagulated patients, he saw me at 8.15am.
I did not need to stop Apixaban, he extracted the tooth, observed me for 15 minutes, packed the socket with dissolving haemostatic gauze, inserted two stitches and off I went to take my morning dose. I had no problems, other than a normal pinkish ooze for 24 hours.
I don't like the idea that one should stop taking a NOAC, just to make a dentist happy - perhaps your father-in-law's doctor could talk some sense into this dentist, or alternatively, refer him to a specialist dentist. I really would not want to stop Apixaban for four days as it sounds like the dentist is not well up on modern medication.
I had a hip replace.due to an accident and the surgeon stopped Apixaban for 3 doses.....that was 1 year ago.I would not have happy stopping it for longer but in the circumstances would have been between a rock and a hard. place.
I'm on Warfarin and didn't have to stop it at all to have a molar extracted. Are you able to ring the dentist yourself to find out just what's needed re the Apixaban?
I had an extraction recently and was advised no need to stop my apixaban, Just to be cautious, I had a morning appointment and took my morning dose after the extraction. You need proper advice on this I think
It takes time for people to get used to new things and NOACS have only been around five years or more.
Not being medically trained I can't advise but if it were me I would miss my last pill the night before and take the next one the morning after. Like most people four days sounds high risk to me Koll.
Hi Koll, I had a wisdom tooth extracted and found it very difficult to get advice. In the end, I missed my morning Apixaban before the appointment, but took the evening one. It all worked a dream with very little bleeding, but of course, we are all different. I'm no medic, but 4 days seems excessive.....hope he does OK, John
Is there any advice on this in the Patient Information Leaflet that comes in every box of Apixiban??
For my last two ablations I simply didn't take the one on the morning of the proceedure.
Four days seems risky to me, especially for a 90 year old.
Thanks for the replies and links.
That's confirmed my thoughts, 4 days is most probably over the top. So I'm going to have a word with the home medical staff/or the dentist, and see if we can get the time he's off Apixaban reduced. I THINK the tooth extraction is a low risk procedure, so just missing one dose or maybe one day's dose should be sufficient.
Our dentist has done several extractions for my husband on warfarin. Does not stop warfarin has to be under 4.! Dentists have book of protocols re medications and cant believe they haven't caught up with NOACs ( DOACs) yet. Maybe discuss with GP. The good news is your Pa in law will be protected more quickly afterwards with Apixaban. I know in the great scheme of things 4 days unprotected is not long but I would be like you as it defies logic. You could contact AFA by email as I have done and they can advise but as they seek advice it's not instant.
I know this is an old thread, but thought I’d reply anyway in case other people happen to read it. I had to have a tooth extracted, the one beside the front tooth, and my dentist wrote to the cardiologist for advice as I’m on Apixaban due to mitral valve disorder and atrial fibrillation and am awaiting surgery. The advice was to stop the apixaban for 4 doses - I was told to take the morning dose the day before but not the evening one, take neither dose on the day of the extraction, and not to take the morning dose on the next day, just start again with the evening one. Personally I thought that was being a bit too cautious, especially as another doctor at the hospital had once mentioned in passing that he didn’t think apixaban needed to be stopped for extractions, but I did as told as I presume the cardiologist had her own reasons for her instructions. I also had to take 600 mg of clindamycin 1 hour before the extraction, this was to reduce the risk of getting endocarditis, something that can happen to patients with a faulty heart valve. The extraction was no trouble at all, it oozed a little blood for a number of hours, but that was all. And I had no nausea from the hefty dose of antibiotic, something I was convinced would happen as most antibiotics make me feel sick.
I’ll be having an implant when the extraction site is fully healed, so presume the instructions will be the same regarding apixaban and clindamycin. I certainly would query being told to stop for 4 days, that sounds rather too long to be without blood thinner.
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