Anticoagulant and Anti-Platelet Medications
Many patients with cardiac problems take either anticoagulant or anti-platelet medications, often referred to a “blood-thinners”. The problem with these drugs is that dental extractions or surgery may result in excessive bleeding during and after the procedure.
Patients who take anticoagulants or anti-platelet medications can provide a management problem balancing the concern for possible excessive bleeding during and after surgery against the danger of stopping anticoagulants or anti-platelet drugs and risking the formation of blood clots within the circulation that can then lead to a stroke.
A stroke is a seriously adverse outcome that may lead to death. Therefore we prefer our patients to continue to take their anticoagulant medications and anti-platelet medications knowing that bleeding can be stopped using a series of local measures. However, sometimes it may be considered appropriate by the surgeon and the cardiologist to modify your medication to allow for a narrow window of reduced anticoagulation around the time of surgery and then allow a return to the usual medications.
If a patient is taking Aspirin, Warfarin or Clopidogrel, it is important that they inform their dentist, especially if they are due to have teeth removed or have any minor dental surgery performed.
There are also new fibrin inhibitors that are used to avoid blood clots forming in the circulation. These include Dabigatran, Rivaroxiban, and Apixaban. It is very important that patients inform Dr Priestland of every drug that they take along with the dose of each drug. All patients are advised that it is always a good idea to have this information carefully recorded in your handbag or wallet at all times.
For those patients taking Warfarin, it is possible to check on the effectiveness of the anticoagulant effect by performing a simple blood test called an INR (International Normalised Ratio). This is a ratio of your ability to stop bleeding compared to an internationally accepted normal value.
- Generally, if you have an INR below 2.0-2.5, then it is safe to have dental extractions and other dental surgical procedures.
- If the INR is above 2.5, then your dentist or surgeon must determine the likelihood of significant bleeding. It is possible to apply other procedures to assist in stopping bleeding, including the use of special haemostatic foams in dental extraction sockets that make the blood clot, and stitches can be used to help apply pressure to the wound and assist in bringing bleeding under control.
- Patients with a raised INR of more than 3.0 should normally have the medication adjusted to bring them nearer to 2.5 but if surgery is unavoidable then special measures may be taken to assist in controlling bleeding.
In more severe cases with a raised INR, and an extensive surgical procedure likely to give rise to significant bleeding, a suspension of Tranexamic acid 5% can be applied to bite packs and pressure applied to stop bleeding. This medication is only available on prescription by your surgeon who will advise you on the need for its use if it is required.
It is important you discuss this, and any medication you are taking when you visit Dr Priestland for a consultation. He will provide personal advice for your situation.
Other posts in this series
- Medication and Dental Surgery: How your medical history influences treatment decisions
- Osteoporosis medication influences dental extractions and dental surgery
- Diabetes and dental treatment or surgery
- Dental extractions and surgery after radiation therapy of the head and neck
- Knee or hip replacement surgery influences future dental management
- The influence of cardiac disease on dental management
- Angina (heart-related chest pain) medications and dental treatment
- Codeine sensitivity or allergy
- Patients who routinely take steroid medications