Periprocedural Factor Xa Inhibitor Interruption and Resumption for Patients With Atrial Fibrillation Undergoing Dental Procedures

BACKGROUND AND OBJECTIVES: In the PERIXa study, a standardized periprocedural interruption protocol for factor Xa (FXa) inhibitors led to very low major bleeding rates and no thromboembolic events among patients undergoing procedures with minimal to low bleeding risk. However, dental procedures showed the highest all-bleeding rate. This sub-analysis assessed bleeding outcomes by dental procedure type, FXa inhibitor, and dosing regimen to inform tailored anticoagulation strategies in dental practice. METHODS: This analysis included atrial fibrillation (AF) patients from PERIXa who underwent dental procedures managed with a standardized FXa inhibitor interruption protocol. All-bleeding events-comprising major, clinically relevant non-major, and minor bleeding-as well as thromboembolic events and all-cause death, were evaluated within 30 days. Intraoperative bleeding severity was reported by dentists using standardized questionnaires. RESULTS: Among 820 patients (mean age 71.3 ±9.4 years; 42.0% female) undergoing dental procedures with periprocedural direct oral anticoagulant (DOAC) interruption per the PERIXa protocol, the overall all-bleeding rate was 5.0%, with major bleeding occurring in only 0.2%. No thromboembolic events or deaths were reported. Bleeding risk did not differ significantly by procedure type, DOAC agent, or regimen, though numerically higher all-bleeding rates were observed with implants and combined procedures. Most dentists reported no or manageable bleeding, with no significant variation across groups. CONCLUSIONS: Dental procedures performed under the PERIXa protocol were associated with low bleeding risk and excellent thromboembolic safety. These findings support the applicability of the protocol across various dental interventions and DOAC regimens in patients with AF.