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Apixaban and "Major" Dental Work

Hi everyone

I have a cyst on my upper jaw at the front. I saw a Maxillofacial surgeon yesterday who said best thing was to remove the tooth, remove the cyst and take away nearby tissue and scrape the bone to make sure they got rid of it. So this is reasonably major dental work.

He said that he would not stop my Apixaban at all, and there would be a blood test just a few hours before the procedure. And he has also allowed an extra 1/2 hour for procedure because of the Apixaban. The blood test is not the one they do for Warfarin, he said, but another one. I didn't ask any further about this.

I was just wondering who else has had fairly major dental work done without halting their Apixaban, or maybe other NOAC's, and how they got on afterwards.

Many thanks

Koll 🙂

PS. I'll be having a "post" fitted afterwards, but not for six months.

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Hi Koll, I had a wisdom tooth removed and it was difficult to get any specific advice. It was done by a dental surgeon attached to my dentist's who specialises in extractions and she knew I was taking apixaban but her instructions said nothing, so I assumed it was OK to take it as normal. No problems and no blood tests, but your treatment sounds far more complex. Hope all goes well, John

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When I read this kind of post I feel concerned re. just who knows,surgeons, what action should be taken (to stop or not to stop )Apixaban in each and every case. The same goes for all the other NOACs.There seems no regulatory body who decides these things and a lot of these medical procedures can be similar.....it should not be too difficult to come up with a good strong guidance plan. How about writing to NICE about your concerns.?

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I'm concerned as such. At the end of the day, if it bleeds more than expected, then it'll be a nuisance but nothing more. But I would like to know how others got on. I wonder why he has allowed the xtra half-hour. Is it just to be more careful (doubtful) or just extra time to deal with any bleeding.

I was really half-expecting him to stop me taking at least one dose before the procedure.

I agree with you, the guidelines should be clearer, or at least more public.

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There are a set of NICE guidelines for procedures and operations while on apixaban. I usually print them out and show them to the consultant concerned. The problem is knowing which category your procedure would come under. X

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I shall get Googling and see what they say, if I can understand it!

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According to Google, NICE advice says this:

Surgery and dental treatment

For procedures associated with no clinically important bleeding risk the procedure can be performed:

• Just before the next dose of apixaban is due

or

• Approximately 18–24 hours after the last dose of apixaban was taken (apixaban should be restarted 6 hours later). This means one dose of apixaban may be missed.

Apparenty, NICE say this is the category for people having 1-3 teeth extracted, so I reckon that's probably the category my procedure would best fit into.

Thank you 🙂

Koll

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That is what I understood Koll - I think missing the one dose before the op and restarting 6-8 hours later sounds sensible to me.

Ouch though and best of luck.

I’ve been having problems with a tooth but my dentist is reluctant to do work unless absolutely essential because of all my complications so will be interested in how you get on. xx

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"I think missing the one dose before the op and restarting 6-8 hours later sounds sensible to me. "

That's what I would have thought/like to do. To be honest, I've missed loads of single doses just because of my memory.

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I don't know the answer Koll but just wanted to wish you good luck with the procedure. X

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Hi Koll, I had 2 implants put in whilst still on apixaban and had no problems also recently had a large wart off my eyelid without problems and apparently the eyelids have lots of blood vessels. My personal opinion is that any external bleeding can be kept an eye on and if necessary and under medical advice I reckon if there were to be lots of bleeding you could maybe miss the next dose. It is bleeding that I cant see that would worry me more.

Your doctor seems quite confident and if anything I think they usually err on the side of caution.

I hope it all goes well for you.

X

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Thanks dedeottie, yes, he was confident and I'm not worried, more interested than anything.

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Thanks Dedeottie.So far I have not 'hit' trouble! My dentist is competent and my only surgery has been for a fairly major accident and you are then 'in the lap of the gods'!

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Hi Koll

My German dentist (private) has taken two wisdom teeth out for me over the last two years and from what I can remember I didn't stop my warfarin.

His wife has AF, is a dentist herself, and I believe he knows what he's doing so I trust him completely. I don't live too far from the surgery and had each tooth out on a Monday early morning. That was so that if I had any issues with bleeding afterwards I could shoot back there. One extraction caused blood seeping for quite a few hours and I did go back to him that time. I was told to bite on a wadding of lint until it stopped. Looking back I didn't really need to go back to him that day.

Each time I had a dissolving dressing put in the socket of where each tooth had been to prevent any infection

I guess they are allowing the extra time for your procedure to ensure the bleeding stops.

Best wishes

Jean

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I had root canal work done without stopping Pradaxa. No problem. Your dentist sounds to be clued up. My dentist is highly qualified and seems to be unfazed by Pradaxa.

Best wishes for a good and pain-free outcome.

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Hi Koll

He sounds as if he is very efficient and knows what he is doing. Perhaps he will be using stitches on the area, so not so much bleeding. Hope all goes well, let us know how it goes.

Cassie

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I was on Apixabin after my ablation for 3 months.

I needed a dental implant and a bone graft prior to the implant which consisted of scraping the jaw and putting in synthetic bone.

I was instructed to stop the Apixabin for 2 days prior to surgery by my dentist.

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I have been on an anticoagulants now for 18 years and had major surgery during that time and you just follow the advice of the medics as they know from guidelines and experience exactly what to advise you to do. Good luck with your surgery.

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Hi......I see you've been on anti coagulants for 18 years.....since i've been on them for 10 years already and will be taking them for the rest of my life, i'm very interested in long term side effects, especially for NOACs......how has your experience been? Are you taking warfarin ot a NOAC?

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For 17 years I took Warfarin but in the last few months I have been put on to Pradaxa as the Stroke Doc recommended for better protection. Warfarin always served me well and Pradaxa changeover has gone unnoticed so all seems well, I too am on this for life due to a stroke caused by PA/F

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Did you have a lot of risk factors for stroke in addition to the afib? Was the afib intermittent or permanent?

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The A/F was on an as and when basis, coming on mainly at night or when I was at rest lasting for many hours at a time, and the only other risk factors I had was that my Mother had a heart attack at 60 years of age, in all other respects I was to my knowledge fit and healthy.

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Thank you for your reply.

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I had wisdom tooth removed and was told no need to stop apixaban. I however adjusted my dosage times for a few days prior to the procedure so that I was at the lowest end of the spectrum when the tooth was removed. I had no bleeding.

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Whilst I was on warfarin I needed something not quite so major and my dentist phoned the anti-coagulation department who told him they couldn't help him. So I just had to wing it and chose to come off warfarin 3 days before the procedure.

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