Anticoagulants & Antiplatelets
Dental Considerations for Patients Taking Rivaroxaban (DOAC)
Treat without interruption — low bleeding risk (rivaroxaban)
SDCEP: for low bleeding-risk procedures, treat without interrupting rivaroxaban; apply local haemostatic measures.
Emergency vs routine management
If EMERGENCY — what to do
- • Do not delay emergency care — treat as early as possible after the last dose.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- • Use local haemostatic measures: oxidised cellulose/collagen packing, sutures, pressure and tranexamic acid 5% mouthwash.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- • If bleeding cannot be controlled with local measures, refer to hospital.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
If ROUTINE — what to do
- • Low-bleeding-risk procedures: no interruption of the DOAC.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- • Once-daily drug: for higher-bleeding-risk procedures, delay the morning dose until ≥ 4 h after haemostasis (or take in the evening).Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- • Morning appointment; limit the extent of surgery per visit.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
Clinical precautions
- • Do NOT interrupt rivaroxaban
- • Local haemostatic measures
- • Treat early in the day and week
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | ROUTINE No bleeding risk for this procedure |
| Supragingival scaling / polish | MODIFY / CAUTION Treat without interruption — low bleeding risk (rivaroxaban) |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Treat without interruption — low bleeding risk (rivaroxaban) |
| Root canal treatment | ROUTINE No bleeding risk for this procedure |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Treat without interruption — low bleeding risk (rivaroxaban) |
| Surgical / bony extraction | MODIFY / CAUTION Miss/delay the morning dose — higher bleeding risk (rivaroxaban) |
| Implant placement | MODIFY / CAUTION Miss/delay the morning dose — higher bleeding risk (rivaroxaban) |
References
- SDCEP 2022 — Management of Dental Patients Taking Anticoagulants
- SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.