BLOOD THINNERS

The information provided here is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is provided to help you communicate effectively with your oral and maxillofacial surgeon or health care provider.

(Anticoagulant or Antiplatelet Medications)

Before having any surgery (especially dental procedures), tell your oral surgeon, dentist or physician about this medication and all medications and supplements you are taking.

Millions of people regularly take anticoagulant or antiplatelet medications (commonly referred to as “blood thinners”) to help prevent heart attack and stroke, and to manage a variety of medical conditions including cardiac arrhythmia and stent placement. These drugs have proven life-saving benefits. However, they can cause side effects such as increased bleeding. 

Patients taking blood thinners can pose a challenge because blood will not clot normally and it could be difficult to stop bleeding. Altered hemostasis can lead to potential complications. However, oral surgeons are often required to manage bleeding as part of routine oral surgery or other dental procedures. 

Hemostasis, the arrest of bleeding, depends on several critical factors:

  • Adequate number of platelets and proper platelet function
  • Vascular integrity
  • Adequate levels of clotting factors

Many pharmaceuticals can compromise hemostasis. 

What are Blood Thinners? 

There are two main types of blood thinners. Anticoagulants, such as heparin or warfarin, work on chemical reactions in your body to lengthen the time it takes to form a blood clot. Antiplatelet drugs, such as aspirin, prevent blood cells called platelets from clumping together to form a clot.

When you take a blood thinner, follow directions carefully. 

Common Anticoagulants:

  • Clopidogrel (Plavix)
  • Coumadin (Warfarin)
  • Dabigatran Etexilate (Pradaxa)
  • Heparin
  • Warfarin
  • Xarelto
  • Lovenox (Low Molecular Heparin)

Common Antiplatelets:

  • ASA (Aspirin)
  • NSAIDS (like Advil)

Is Oral Surgery Safe When Taking Blood Thinning Medications?

Patients taking blood thinners is not a contra-indication to having oral surgery. While it is extremely rare for common dental procedures to cause potentially life-threatening complications, it makes sense to take as few chances as possible. 

How is the Patient Taking Blood Thinners Managed When Undergoing Oral Surgery?

Pre-Operative Appointment – The potential risks and benefits of stopping the anticoagulant medication must be carefully weighed. The following will help Dr. McDonald in the decision-making process:

  • Completion of an accurate medical history shall be obtained. (It is very important to share information about your medication.)
  • Your Cardiologist and/or physician may be contacted regarding management of your medications.
  • Possible laboratory testing may be ordered. 

            INR – The International Normalized Ratio (INR).  The INR measures anticoagulation status. 

                      The normal individual should have an INR of 1.0.

            PT – Prothrombin Time – A test to measure extrinsic pathway of clotting

            aPPT – The activated Partial Thromboplastin Time (aPTT) is utilized to assess coagulation.  This test

                         measures the intrinsic and common pathways.  A normal test time is 25 – 40

                         second

  • Scheduling your surgery early in the day and allowing plenty of time for rest afterwards is important.

During Your Surgery:

Products to control bleeding and stabilize blood clots maybe placed in the surgical site (s).

Post Operative Phase:

  • Application of pressure on surgical site (such as biting down on gauze)
  • Possible Tranexamic Acid, a topical antifibrinolytic rinse.