Apixaban

[Tmax71]

Hi, I am due to get two teeth out at the dental hospital, can anyone tell me if I need to stop the apixaban before surgery? Thanks in advance.

[BobD Volunteer]

Whether you need to and whether they may want you to are two different questions. I know many dentists quite happy to do extraction whilst patients are anticoagulated but others who go into a panic at the thought of it. If they fall into that category I would be inclined to get you cardiologist to tell them what they should do and be so guided.

[Sebhel in reply to BobD]

I went through similar experience starting with v Painful toothache but just timed appointment for 10 am - time when due for apixaban which I delayed taking till after extraction! My only issue / worry was what type of painkillers I could use ?

[Hidden]

I just had medium-level dental surgery, one tooth extracted and work done removing a cyst. Because of that work, it was apparently equivalent to about 3 or 4 teeth being removed. I had to stop apixaban for a while, not long, and they told me what to do.

As I remember it, they had a break-off point where if the work was equivalent to having 1-2 teeth removed you needn't stop, but if it was more you did need to stop, not certain about my figures but that's the gyst of it! Because of the short half-life of apixaban, I only stopped taking apixaban 1 day or so before the op.

Don't rely on what I say, just telling you what happened with me.

Hope your work goes well.

[Tmax71 in reply to Hidden]

Thanks.

[Hidden]

I take Apixaban and found it very difficult to get advice from dentist, INR and Arrhythmia Nurse when I had to have a wisdom tooth removed. In the end, I decided not to take the dose before the extraction on the basis of that is what is often recommended for most procedures. The extraction was a bit of a non-event with no excessive bleeding. I have since found the NICE recommendations and have added a link below. If you click on Management for Apixaban and scroll down there is a section on dental work......good luck!

cks.nice.org.uk/anticoagula...

[terryw]

Hi Tmax71. I had a tooth extracted last year after being advised not to stop Apixaban despite my queries. My extraction was followed by two trips to the Dentist (one for stitches), and two to A & E for bleeding. One plus point was I learnt about the drug Tranexamic (non adrenaline version) which helps to clot blood. Good luck,Terry

[Celtic27]

Hi t max I wouldn't tell you which way to go as I'm not medically trained to do so! You should try asking your cardiologist and ask your dentist before you get there I hope all goes well take care x

[Buffafly]

I was going to have a broken tooth with previous root canal treatment extracted in hospital and at the consultation/examination before was told that because of possible complications I would need to miss a dose of Apixaban and need packing and stitching. Fortunately the consultant suggested a different management plan so thankfully I can avoid the extraction for now. My impression (anecdotal evidence) is that NHS dentists do not bother with the packing/stitching procedure. My consultant was not impressed that my dentist referred me because I was on anticoagulation, she said the complexity of the extraction warranted it but not the anticoagulation and she was going to write to the dentist to explain management of any future extractions and I shall ask for a copy and report back!

[Dodie117]

I had tooth extraction but did not stop apixaban. On my own imitative, I did manipulate the times I take my tablet so that I was at the lowest point in the anticoagulant cycle ie taking the dose shortly after the extraction

[Geza10 in reply to Dodie117]

Good thinking that's what I will do as I'm going to have a couple of implants

[dizzielizzie1 in reply to Geza10]

Hi there-- I had one implant last year and my dentist told me NOT to stop taking the Apixaban, as he said it was prescribed for a reason and so I should not stop taking it. He was not at all concerned about the risk of bleeding and said he would be putting in some tiny stitches afterwards. I also opted for non-adrenalin anaesthesia. The procedure was so straightforward, nothing like I thought it would be. It was not at all painful and there was absolutely no unusual bleeding, but I did wait for a little while at the practice so that they knew everything was Ok before I left for home. Hope everything goes well for you. Dizzie Lizzie

[Geza10 in reply to dizzielizzie1]

Thank you dizzielizzie

Much appreated advice I will do as you have did you get your implant in GB or overseas

[dizzielizzie1 in reply to Geza10]

I had my implant here in UK from a very knowledgeable dentist who only does implants. He teaches dentists here and abroad how to do implants and was recommended by my NHS dentist. You will have to take antibiotics for two weeks afterwards , to avoid any infection around the site of the implanted post and I had a tiny little soft toothbrush to use in that area. You will also need to use a special mouthwash for two weeks. Your dentist doing the implant should talk you through everything. One thing that is important to remember, is that after an implant ,you need to have a really good oral hygiene regimen, to avoid any gum disease around the implant. I had already had work done earlier in the year by the endontologist at the practice, who had contacted my GP about my taking Apixaban, and was told I didn't need to stop. That would have been on my records, and reassured the dentist doing the implant that it was Ok for me to carry on taking the Apixaban. It would appear that some dentists are more confident than others, about treating patients taking Apixaban . Any further questions , please ask.

[Geza10 in reply to dizzielizzie1]

Thank you very much that has clarified everything at least I know I can proceed sorry if I sound a bit nosy but have you got his name

[dizzielizzie1 in reply to Geza10]

Dr Colin Neil

[supergranny]

Check with the hospital beforehand, you may need to stop one dose!

[Xerxes8840]

According to the ADA (American Dental Assoc) it should be stopped 24-48 hours before procedure- but consult with your cardiologist.

[Mal7896]

I stopped 48 hours before extraction

[DK81]

My dentist told me that it was up to her to decide what to do, if a bleeding risk might occur, and not up to any cardiologist or other doctor. She said that it was her responsibility, as I was being treated by her, and she would have questions to answer if anything went seriously wrong while I was under her care. She made herself very clear!

[gorpo59]

I've had teeth out, root canal work, and flap surgery with no interruption to Apixaban. I'm 59. Hope that helps. Bleeding never an issue in my case.

[Roseyuk]

I need one tooth removed

And also on Apixaban

Asked my cardiologist last visit in December

And he recommended two days of

Apixaban before and continue days after extraction

That’s what he recommended for me

Still waiting to get it done though

So can’t comment further

[Hidden]

I had an extraction of a big tooth. I think it was No. 38 lower jaw.

No issues with bleeding. Upper jaw extractions tend to bleed more.

I'm on Apixaban but changed to Pradaxa two days before the appointment because

there is no antidote for Apixaban ( not yet here in Australia ).

I took a dose early morning and the extraction time was 4pm. I took the next dose

a bit delayed at 10pm. One day later back to Apixaban.

I was told that for normal extractions it is not recommended to stop anticoagulant.

I checked the guidelines for dentists and it is correct.

[Hidden in reply to Hidden]

To change to Pradaxa was my own idea.