When to stop ELIQUIS prior to procedure: A comprehensive guide

October 11, 2025 •

4 min read

According to the FDA, Eliquis (apixaban) must be temporarily discontinued before surgery or invasive procedures to minimize the risk of serious bleeding. The exact timeline for when to stop ELIQUIS prior to procedure depends on the specific type of intervention and the patient's individual health profile. Never stop taking this anticoagulant without direct instruction from your prescribing healthcare provider, as abrupt discontinuation can lead to dangerous blood clots.

Quick Summary

This guide provides detailed recommendations and considerations for temporarily interrupting Eliquis (apixaban) before medical or dental procedures, based on the associated bleeding risk. It covers timelines for low-risk versus high-risk procedures, the importance of factoring in kidney function, and the process for safely restarting the medication afterward. It also addresses the critical balance between reducing bleeding risk during the procedure and preventing dangerous clot formation.

Key Points

Consult your doctor before stopping: Never discontinue Eliquis without explicit guidance from your prescribing healthcare provider to avoid dangerous blood clots, such as stroke.
Low-risk procedures: For procedures with minimal bleeding risk, Eliquis is typically held for a specific period prior.
High-risk procedures: A longer hold period is generally required for procedures with a moderate to high risk of bleeding.
Kidney function matters: Patients with impaired kidney function may need a longer Eliquis hold time, as the drug is cleared more slowly from their system.
Restarting Eliquis: The medication is restarted once adequate hemostasis is achieved, after a duration determined by the bleeding risk and your doctor's assessment.
Balance bleeding and thrombosis: Your doctor will weigh the risk of procedural bleeding against the risk of a thrombotic event when determining your specific plan.
Consider bridging therapy: For patients at very high risk of blood clots, doctors may sometimes use a shorter-acting anticoagulant, though this is less common with Eliquis.
Be vigilant for signs of bleeding: During the hold period and upon restarting, be aware of symptoms of bleeding, such as unusual bruising or persistent nosebleeds.
Special timelines for neuraxial procedures: Procedures like epidurals require Eliquis to be stopped for a specific, longer duration beforehand due to the risk of spinal hematoma.

Eliquis, the brand name for apixaban, is a direct-acting oral anticoagulant (DOAC) prescribed to prevent dangerous blood clots in patients with conditions like atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE). Because its purpose is to inhibit blood clotting, it must be carefully managed before any surgical, dental, or other invasive procedure to prevent excessive bleeding. Managing Eliquis in the perioperative period involves a careful balancing act between the risk of bleeding during the procedure and the risk of a blood clot forming when the medication is paused.

Assessing procedure bleeding risk

Before any procedure, your healthcare provider will assess its associated bleeding risk. This assessment, combined with your personal health profile, will determine the length of time Eliquis should be held. Procedures are generally categorized into low-risk, moderate-risk, and high-risk categories, each with different discontinuation guidelines.

Low-bleeding-risk procedures

For procedures with a low risk of bleeding, the recommendation is often to stop Eliquis a certain period in advance. This duration is considered sufficient because Eliquis has a relatively short half-life of approximately 12 hours, meaning its anticoagulant effect diminishes significantly over time. Examples of low-risk procedures include:

Minor skin surgery
Cataract surgery
Most dental extractions
Diagnostic endoscopy without biopsy or polypectomy

For some procedures with minimal bleeding risk, such as routine dental cleaning or a simple biopsy, a doctor may even advise against stopping the medication at all. The decision should always be made by a healthcare provider, balancing the minimal bleeding risk against the risk of a serious clotting event.

Moderate- and high-bleeding-risk procedures

For procedures that carry a moderate to high risk of bleeding, a longer hold time is necessary. Guidelines typically recommend discontinuing Eliquis for a specific duration prior to the procedure. This time ensures that the anticoagulant effect is sufficiently minimized to allow for safe hemostasis (the process of stopping bleeding) during the procedure. Examples of these procedures include:

Major abdominal surgery
Orthopedic surgery (e.g., hip or knee replacement)
Cardiac surgery
Neurosurgery
Colonoscopy with polypectomy

Special consideration: Neuraxial anesthesia

For procedures involving neuraxial anesthesia (spinal or epidural), a longer discontinuation period is required due to the risk of spinal or epidural hematomas, which can cause paralysis. Guidelines recommend stopping Eliquis for a specific duration before the procedure.

The crucial role of kidney function

A patient's kidney function is a critical factor when determining the timing for holding Eliquis because the drug is primarily cleared from the body by the kidneys. In patients with impaired kidney function, Eliquis can remain in the system longer, requiring an extended hold time to ensure safety.

Normal to mildly impaired kidney function (CrCl > 50 mL/min): Standard hold times may apply, as determined by a healthcare provider.
Moderately impaired kidney function (CrCl 30–50 mL/min): The hold time may need to be extended. For example, some guidelines recommend a longer hold for high-risk procedures.
Severely impaired kidney function (CrCl < 30 mL/min): Patients may need even longer interruption periods.

Your healthcare provider will assess your renal function using a creatinine clearance (CrCl) or estimated glomerular filtration rate (eGFR) test to make an informed decision.

Balancing thrombosis and bleeding risk

The decision to stop Eliquis is never taken lightly, as it carries a risk of potentially life-threatening thrombotic events, such as stroke, during the interruption period.


Feature	Holding Eliquis for a procedure	Not holding Eliquis
Primary Risk	Thrombosis (blood clots): Increases the risk of stroke, DVT, or PE during the period the medication is paused.	Bleeding: Significantly increases the risk of excessive bleeding, which can be difficult to control, during and after the procedure.
Risk Mitigation	Minimized by keeping the interruption period as short as safely possible and restarting the medication promptly, as advised by a doctor.	Can be managed by local hemostatic measures for very low-risk procedures, but dangerous for higher-risk interventions.
Action Required	Requires careful, individualized planning by a healthcare professional, factoring in the patient's underlying condition and kidney function.	Not an option for most invasive procedures due to the high risk of serious bleeding complications.
High-Risk Patients	Patients at a very high risk of blood clots may require "bridging therapy" with another anticoagulant, although this is generally not necessary with Eliquis.	This is an unacceptable strategy for this patient group, as even minor bleeding can become life-threatening.

Restarting Eliquis after the procedure

Just as important as stopping the medication is knowing when and how to restart it. The primary criterion for restarting Eliquis is that adequate hemostasis has been achieved, meaning the surgical site is stable and there is no significant bleeding. The timing depends on the procedure's bleeding risk:

Low bleeding risk: Eliquis can often be restarted after a specific duration following the procedure.
High bleeding risk: Restarting may be delayed, depending on the specifics of the procedure and the surgeon's judgment.

Your healthcare provider will provide precise instructions on when to resume your medication. Never assume the timing on your own.

Conclusion

Navigating the process of temporarily stopping Eliquis for a medical or dental procedure requires careful, individualized planning in consultation with your healthcare team. The specific timing is determined by the procedure's bleeding risk, your kidney function, and the inherent risk of a blood clot forming while the medication is paused. For low-risk procedures, a certain hold period is often sufficient, while high-risk interventions may require a longer duration. The most critical takeaway is to never alter your medication schedule without specific guidance from your doctor, as both insufficient and excessive interruption carry significant risks. By following a clear, professionally managed plan, you can safely undergo your procedure while minimizing complications.

For more detailed clinical guidelines, you can consult authoritative resources such as the American College of Chest Physicians (CHEST) guidelines.

(Note: Consult your own healthcare provider before making any changes to your medication schedule. This article is for informational purposes only and does not constitute medical advice.)

Frequently Asked Questions

For most dental procedures with low bleeding risk, such as a simple tooth extraction, Eliquis is typically held for a certain period prior. For more complex oral surgery, a longer hold may be necessary. Always consult your dentist and prescribing doctor for specific instructions.

For a colonoscopy, the hold time for Eliquis depends on the bleeding risk. If only diagnostic, a standard hold period is applied. If a polypectomy is anticipated or performed, a longer hold is usually required.

Stopping Eliquis suddenly, without medical supervision, can increase your risk of serious blood clots, which could lead to a life-threatening stroke or pulmonary embolism. Never stop the medication without talking to your doctor.

If you miss a dose while preparing for a procedure, contact your healthcare provider immediately. They will advise if the procedure needs to be rescheduled or if it is still safe to proceed. Never guess and proceed, as this could lead to bleeding complications.

You can typically restart Eliquis once your healthcare provider confirms that adequate hemostasis (the stoppage of bleeding) has been achieved. This often happens after a specific duration, depending on the procedure's bleeding risk and your doctor's assessment. Your doctor will provide the exact timing.

No. Eliquis and similar anticoagulants must be stopped for a specific, longer duration before a spinal or epidural procedure to avoid the risk of a spinal hematoma.

Yes, impaired kidney function affects how quickly your body clears Eliquis. Patients with moderate to severe kidney problems may need a longer hold time before a procedure, as determined by their doctor based on their renal function tests.