Low risk of bleeding complications

For a patient who is taking a DOAC and requires dental treatment that is likely to cause bleeding with a low risk of bleeding complications (see Bleeding risks for dental procedures):

• Treat the patient according to the general advice for managing bleeding risk, without advising the patient to miss or delay a dose of their medication.

In addition:

• Plan treatment for early in the day to allow for monitoring and management of bleeding complications, should they occur.

• Limit the initial treatment area (e.g. perform a single extraction or limit root surface debridement to 3 teeth, then assess bleeding before continuing).

• Use local haemostatic measures to achieve haemostasis. Strongly consider suturing and packing, taking into account all relevant patient factors (see Haemostatic measures).

The available evidence suggests that it is not necessary to interrupt DOAC medication for dental procedures that are likely to cause bleeding, but which have a low risk of bleeding complications (see Bleeding risks for dental procedures).

Because the bleeding risk for these procedures is likely to be low, the balance of effects is in favour of continuing the DOAC treatment without modification to avoid increasing the risk of a thromboembolic event. Anticoagulant therapy is prescribed for significant clinical indications and should not be interrupted unnecessarily.

Although treating a patient in the morning, as advised, is more likely to coincide with the relative peak of drug concentration, this risk is judged to be outweighed by the importance of being able to deal with a bleeding complication, should it occur, within surgery hours.