Senior woman smiling with dentist before a tooth extraction while taking Eliquis

Undergoing a tooth extraction while on Eliquis can be nerve-wracking. The fear of bleeding complications may leave you wondering if it’s necessary to stop your blood thinner medication. Unfortunately, the answer isn’t always straightforward. This guide will help you understand when to stop Eliquis before a tooth extraction, including the risks, safety guidelines, and key steps for coordinating with your healthcare team. You’ll learn how to make the safest choice based on your individual medical history, the complexity of the procedure, and your bleeding risks.

Understanding Eliquis (Apixaban)

Eliquis is a widely prescribed blood thinner. It belongs to a class of medications called direct oral anticoagulants (DOACs). These drugs prevent blood clots. They do this by blocking Factor Xa, a key protein in clotting. Understanding how Eliquis works can help. It allows you to make informed decisions about dental procedures.

Apixaban is the generic name for Eliquis. It’s the active ingredient that gives Eliquis its anticoagulant effect.

Doctors commonly prescribe Eliquis for a range of conditions, including:

Pharmacokinetic Properties of Eliquis

Pharmacokinetics is the branch of pharmacology that studies how the body affects a substance, such as a medication, after it is administered. It focuses on the movement of a drug into, through, and out of the body over time, often summarized by the acronym ADME.

  • Absorption: How the drug enters the bloodstream from its site of administration.
  • Distribution: How the drug spreads throughout the body’s tissues and fluids.
  • Metabolism: How the body chemically alters the drug, typically in the liver.
  • Excretion: How the drug and its metabolites are eliminated from the body, often via the kidneys in urine or the liver in bile/feces

Understanding how your body processes Eliquis helps determine safe timing for dental procedures.

  • Half-life: Eliquis has a half-life of approximately 12 hours. This means your body eliminates half the medication every 12 hours.
  • Complete elimination: It takes about 5 half-lives (roughly 60 hours or 2-3 days) for your body to eliminate 95% of the medication.
  • Kidney function matters: Your kidneys help eliminate Eliquis. If you have kidney problems, the medication stays in your system longer.

These pharmacokinetic properties are important. They form the basis for the 24–48 hour hold guidelines before certain dental procedures.

Risks Associated with Tooth Extraction on Eliquis

Balancing bleeding and clotting risks is crucial when planning dental extractions.

Bleeding Risk Factors

Several factors increase your bleeding risk during tooth extraction:

  • Procedure complexity: Simple single-tooth extractions have a lower bleeding risk. The risk is higher with multiple extractions. It also increases with surgical procedures.
  • Number of teeth: Extracting multiple teeth increases bleeding surface area and risk.
  • Patient age: Older adults may have slower healing and higher bleeding risk.
  • Kidney function: Reduced kidney function means Eliquis stays in your system longer.
  • Other medications: Blood thinners, NSAIDs (like ibuprofen), and certain supplements can increase bleeding risk.

Thrombotic Risk Factors

Stopping Eliquis temporarily increases your risk of blood clots:

  • Stroke history: Previous strokes indicate higher clotting risk.
  • Reason for Eliquis: AFib, DVT, or PE history affects your clotting risk level.
  • CHADS₂ score: This CHADS₂ scoring system helps predict stroke risk in AFib patients. Higher scores mean greater risk when stopping anticoagulation.
  • Duration of medication: Longer holds increase thrombotic risk.
  • Other risk factors: Age over 75, diabetes, heart failure, or hypertension increase clotting risk.

Guidelines for Stopping Eliquis Before Extraction

The decision to stop Eliquis depends on balancing bleeding and clotting risks.

Low-Risk Procedures

Simple extractions often don’t require stopping Eliquis. These include:

  • Single tooth extraction
  • Simple wisdom tooth removal
  • Routine dental surgery with minimal tissue trauma

When continuation is acceptable:

  • Your dentist can achieve good local bleeding control
  • You have no additional bleeding risk factors
  • The extraction site is easily accessible for pressure application

Key local measures for continued therapy:

  • Pressure gauze application for 30-45 minutes
  • Sutures to close extraction sites
  • Hemostatic agents like gelatin sponge
  • Tranexamic acid mouthwash
  • Detailed post-operative bleeding instructions

Research shows there is no major difference in bleeding. This is true whether DOACs are continued or stopped. The finding applies to simple dental extractions. It holds when proper local measures are used.

Moderate/High-Risk Procedures

Complex extractions may require temporarily stopping Eliquis:

  • Multiple tooth extractions (3+ teeth)
  • Surgical extractions requiring bone removal
  • Impacted wisdom teeth removal
  • Extractions in patients with bleeding disorders

Recommended hold times:

  • Normal kidney function: Stop 24 hours before procedure
  • Moderate kidney impairment: Stop 48 hours before procedure
  • Severe kidney impairment: Consult physician for individualized timing

Local Hemostatic Measures During Extraction

Effective local bleeding control reduces the need to stop Eliquis.

Pressure Gauze & Sutures

  • Pressure application: Bite down firmly on gauze for 30-45 minutes after extraction. This allows initial clot formation.
  • Gauze replacement: Change gauze every 30 minutes if bleeding continues. Avoid frequent checking, which can disrupt clot formation.
  • Suture placement: Your dentist may place sutures to bring tissue edges together. This reduces bleeding surface area and promotes healing.
  • Suture types: Dissolvable sutures typically dissolve in 7-10 days. Non-dissolvable sutures require removal in 5-7 days.

Hemostatic Agents

There are several common hemostatic agents. These include gelatin sponges and oxidized cellulose. Collagen plugs and bone wax are also used. These materials are placed in the extraction site to help control bleeding. Gelatin sponges and oxidized cellulose are absorbable and support clot formation. Collagen plugs promote platelet aggregation. Bone wax is used sparingly to stop bleeding from bone surfaces.

Tranexamic Acid Mouthwash Protocol

Tranexamic acid is an antifibrinolytic agent. It prevents clot breakdown and reduces bleeding.

Preparation: 10mL of 5% tranexamic acid solution

Usage instructions:

  • Rinse gently for 2 minutes
  • Do not swallow
  • Use 4 times daily for 5-7 days
  • Start immediately after extraction

Benefits: Studies show a clear drop in bleeding after extractions. This happens when hemostatic agents are used. The effect is stronger when combined with other local measures.

Contraindications: History of blood clots, kidney disease, or color vision problems may preclude use.

When to Restart Eliquis Post-Extraction

Eliquis should be restarted once bleeding is fully controlled. The extraction site must have a stable clot and no active bleeding. The FDA recommends restarting the medication as soon as adequate hemostasis is achieved. There is no exact timing listed, as it depends on the procedure and how well bleeding is managed. Factors like age, kidney function, and overall stroke or clot risk may also affect timing. 

Always follow your dentist’s advice. Talk to your prescribing doctor before restarting Eliquis. Coordination between both is important.

Coordinating Care

Successful management requires coordination between your healthcare providers.

Communicating with Your Dentist and Physician

Consider sharing your full medication list and medical history with both your dentist and physician. It may help to carry a medication alert card that mentions your anticoagulant therapy. In complex situations, coordination between both providers might be useful. It’s a good idea to document any decisions made about stopping or continuing Eliquis. Keeping emergency contact details for both providers can also be helpful.

Patient Checklist Before Extraction

You may consider asking your dentist questions like:

  • What type of extraction procedure is planned?
  • What local bleeding control measures will be used?
  • How long should I expect bleeding after the procedure?
  • When should I be concerned about bleeding?
  • What pain medications are safe with Eliquis?

You may consider asking your physician questions like:

  • What is my stroke/clot risk if I stop Eliquis temporarily?
  • Do I need to adjust my Eliquis dose before or after extraction?
  • Are there any other medications I should avoid?
  • When should I restart my normal Eliquis schedule?

What to tell your dentist before the procedure:

  • Complete list of medications and supplements
  • Recent lab results (kidney function, INR if available)
  • History of bleeding or clotting problems
  • Previous dental extraction experiences
  • Current health status and recent changes

FAQs on Eliquis and Dental Extractions

Do you need to stop Eliquis before tooth extraction?

It depends on how complex the extraction is. Bleeding and clotting risks also matter. The choice of local hemostatic options plays a role, too. The decision should be made jointly with your dentist and prescribing physician. Simple extractions often don’t require stopping Eliquis if proper local measures are used.

Can I extract my tooth while on blood thinners?

Yes, for simple extractions with appropriate local bleeding control measures. Complex cases may require temporary medication hold and medical consultation. Your dentist will assess the specific procedure and your individual risk factors.

Do I need to go off apixaban before dental surgery?

Low-risk surgeries may not require stopping Eliquis. Moderate to high-risk procedures often need a 24-48 hour hold, adjusted for kidney function. The decision depends on balancing bleeding and clotting risks.

When to restart apixaban after dental extraction?

Typically 6-24 hours post-procedure once bleeding is controlled and hemostasis is stable. High bleeding risk procedures may require longer delays. Coordinate restart timing with your prescribing physician.

How long does 5mg of Eliquis stay in your system?

Eliquis has a half-life of approximately 12 hours. It takes about 2-3 days for 95% elimination from your system. This timeline informs the hold recommendations before dental procedures.

How long before surgery can I stop taking Eliquis?

Stop 24 hours before low-risk procedures and 48 hours before moderate to high-risk procedures. Extend the hold time if you have kidney impairment. Always follow your physician’s specific instructions.

What if I forget to stop Eliquis before my extraction?

Contact your dentist immediately. They may postpone the procedure or proceed with enhanced local bleeding control measures. 

Are there alternatives to stopping Eliquis?

Yes, enhanced local hemostatic measures can often allow procedures to proceed without stopping anticoagulation. These include specialized gauze, hemostatic agents, sutures, and tranexamic acid mouthwash.

What pain medications are safe with Eliquis?

Acetaminophen (Tylenol) is generally safe. Avoid NSAIDs like ibuprofen, aspirin, or naproxen, which can increase bleeding risk. Always check with your pharmacist or physician before taking new medications.

How do I know if I’m bleeding too much after extraction?

Contact your dentist if you experience bright red bleeding that doesn’t stop with pressure, blood clots larger than a quarter, or continuous bleeding for more than 6-8 hours after extraction.

Final Takeaway

Remember, dental extractions while on Eliquis need careful planning. Your healthcare team must work together. Good preparation is key. Clear communication helps, too. Most procedures can be done safely. This is possible with continued anticoagulation or short, proper breaks.

Managing your Eliquis therapy doesn’t have to strain your budget. With soaring prescription medication costs, Prescription Point offers an affordable solution to help you maintain consistent treatment. You can order Eliquis from Canada and access the same quality medication at a fraction of the cost, ensuring your anticoagulation therapy remains uninterrupted.

References

Prescriptionpoint.com is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Always consult a doctor before beginning a new health care regimen.

Anticoagulants Drugs Eliquis

Post Tags:

Related Posts

Eliquis (apixaban) is a commonly prescribed blood thinner for the older adults. This medication helps prevent dangerous blood clots. It treats atrial fibrillation, deep vein thrombosis, and pulmonary embolism. People over 70 need special attention when taking Eliquis. Age-related changes affect how the body processes medications. Older adults often take […]

Prescription drug prices in the U.S. are higher than in many other countries. To reduce costs, the U.S. launched programs to import drugs from Canada. The goal is to make medications more affordable for American patients. The FDA’s rule points to high U.S. drug prices. These prices are driving cross-border […]

If you’ve been prescribed Gemtesa for overactive bladder, you may have experienced sticker shock at the pharmacy. With a list price of around $552 for a 30-day supply, Gemtesa ranks among the more expensive overactive bladder medications available today. For many Americans, especially those on fixed incomes, high Gemtesa costs […]