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DOAC Dental Procedure — RACP Adult Medicine MCQ

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EasyClinical PharmacologyDOAC Dental ProcedureRACP Adult Medicine

A 60-year-old man on apixaban 5 mg BD for AF undergoes an uncomplicated tooth extraction. His dentist asks about holding the DOAC. According to the 2025 DOAC perioperative guidelines, what is the recommended approach for dental extraction?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Do not hold apixaban – perform the procedure on anticoagulation

Simple dental procedures (single tooth extraction, endodontics, scaling) are classified as procedures with low bleeding risk. The 2025 DOAC practical guidelines recommend that apixaban (and other DOACs) can be continued for low-bleeding-risk procedures including dental extractions, as the bleeding risk is managed with local haemostatic measures (gauze pressure, tranexamic acid mouthwash, surgicel). Holding DOACs for dental work exposes patients to unnecessary thromboembolic risk. For more complex oral surgery (multiple extractions, dental implants), holding 1–2 doses may be appropriate.

Reference: 2025 – DOAC Practical Guidelines; eTG – 2025 – Haematology