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Pharmacology · patient case question

The patient also requires extraction of a hopeless tooth. Regarding the apixaban, what is the usual pre-surgical instruction?

Patient case: Polypharmacy — Cardiovascular & GI

demo: 68-year-old male

chief: “I need a crown on my lower left molar.”

history: Hypertension, gastroesophageal reflux disease, atrial fibrillation, hyperlipidemia, gout. Non-smoker.

meds: Lisinopril, omeprazole, verapamil, apixaban, rosuvastatin, allopurinol

findings: BP 132/84 mmHg. Generalized attrition. Tooth #19 with fractured MOD amalgam, no pulpal symptoms. No active periodontal disease.

  1. Discontinue it approximately 2 days before the surgical procedure, in consultation with the physician
  2. Discontinue it 7 days before, as with aspirin
  3. Substitute warfarin for the week before surgery
  4. Continue it and give vitamin K on the day of surgery
Show answer and explanation

Correct answer: A. Discontinue it approximately 2 days before the surgical procedure, in consultation with the physician

  • A. Correct. Apixaban has a short half-life, so a hold of roughly 2 days before an invasive procedure is the conventional recall answer. Any interruption of anticoagulation is a shared decision with the prescribing physician.
  • B. A 7-day hold reflects the irreversible platelet inhibition of aspirin, not a direct oral anticoagulant.
  • C. Bridging with warfarin would prolong, not shorten, the period of altered coagulation.
  • D. Vitamin K reverses warfarin, not factor Xa inhibitors.

Note: For routine simple extractions many current protocols keep DOACs uninterrupted and rely on local hemostatic measures. Know both the recall answer and the modern trend.

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