Medical management of patients on blood thinners for dental surgery: is a ‘drug holiday’ necessary?
An increasing number of patients are taking antiplatelet or anticoagulant medications, or both. These drugs are prescribed to those who are at high risk for or who have had a thromboembolic event (e.g., blood clot). They include patients who have experienced a pulmonary embolism, deep‑vein thrombosis or have nonvalvular atrial fibrillation, a cardiac arrhythmia that predisposes them to clot formation. Antiplatelet drugs include clopidogrel, ticlopidine, prasugrel, ticagrelor and aspirin. Common anticoagulant drugs include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Lixiana), rivaroxaban (Xarelto), and warfarin (Coumadin).
Lots of patients ask if they should stop taking their blood thinners before surgery, the most common procedure being a tooth extraction. The answer is that it depends on the bleeding risk anticipated for the surgery, something that is decided by your surgeon beforehand. Every patient is different however generally speaking low risk procedures do not require drug cessation such as fillings, cleanings, crowns, simple implant placement, and simple extractions. Treatments where it may be recommended include high risk procedures such as extracting more than 3 teeth, surgical extractions, and periodontal surgery. To help in the decision-making process for these treatments we may order one or more diagnostic blood tests, such as prothrombin time (PT) or International Normalized Ratio (INR), and make a judgment based on our clinical experience. I also like to ask my patients if they’ve ever had a procedure like this before and how it went. Past information on similar surgeries is an important factor when evaluating bleeding risk.
Even in scenarios where bleeding risk is predicted to be low it’s important to always be prepared for the worst case scenario. For every surgery I perform I am prepared with gauze, resorbable collagen, collagen membranes, bone wax, and sutures to manage every scenario that may happen. No surgery is the same, even the “most simple” extractions can become challenging in a second.
This topic is one that I’m passionate about, one that I’ve published a paper on. I believe every surgeon, and patient, should be fully informed and prepared prior to undergoing surgery when blood thinners are in question. If this topic interested you and you’re seeking more information feel free to read the entire article here!
