How long to stop eliquis before tooth extraction

posted: Aug. 07, 2015.

Dental work isn’t performed in a vacuum — the state of your general health can have an impact on procedures and vice-versa. This is especially true if you’re taking certain medications like blood thinners.

Blood thinners such as Warfarin or Clopidogrel are used for a number of medical conditions as an anti-coagulant (inhibiting blood from clotting). They’re commonly part of a stroke or heart attack prevention strategy in patients with cardiovascular disease, or those with tendencies for thrombosis (blood clot formation within blood vessels) or pulmonary embolisms (blood clots within the lungs). They’re also used with patients with artificial heart valves or on a temporary basis with patients who’ve recently undergone knee replacement or similar surgical procedures.

In most cases, dental work won’t be affected by your use of a blood thinner. An issue might arise, however, if an invasive procedure has the potential to cause bleeding, like a tooth extraction or gum surgery. Because the blood doesn’t clot normally it may be difficult to stop the bleeding during such procedures.

To avoid undue complications, it’s always best to let your dentist or oral surgeon know what medications you’re taking, especially blood thinners (this includes low-dose aspirin, a common over-the-counter drug that’s often prescribed as a mild blood thinner). Depending on the procedure and your dosage, they may consult with your prescribing doctor to see if temporarily stopping the medication or reducing the dosage is an acceptable precautionary measure for your dental treatment. Your dentist may also take precautions during the procedure to help reduce bleeding such as using haemostatic agents around the wound site to help stabilize blood clotting, while carefully suturing the wound to avoid disrupting smaller blood vessels (capillaries) that easily bleed.

If your dosage has been temporarily stopped or reduced, you’ll usually be able to resume blood thinners immediately after the dental procedure. Working together, your dentist and doctor will help ensure that your health won’t be at risk and your dental procedure will occur without undue complications.

If you would like more information on dental work precautions with medications, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Surgery & Blood Thinners.”

Management of anticoagulation before and after dental procedures requires careful, patient-specific evaluation of the risk of bleeding associated with the dental procedure as well as the risk of thromboembolism associated with the underlying disease state for which anticoagulation is indicated. Patient specific management plans will be made in consultation with the dentist performing the procedure.

 Low bleeding riskModerate bleeding riskHigh bleeding riskProceduresSuggestions

Supragingival scaling Simple restorations Local anesthetic injections	Subgingival scaling Restorations with subgingival preparations Standard root canal therapy Simple extractions Regional injections of local anesthetics	Extensive surgery Apicoectomy (root removal) Alevolar surgery (bone removal) Multiple extractions
Do not interrupt anticoagulant  therapy Use local measures to control bleeding	Interruption of anticoagulant therapy in not necessary Use local measures to prevent or control bleeding Consult w/ dentist to determine comfort with use of local measures to prevent bleeding when anticoagulation is not interrupted	May need to interrupt anticoagulant therapy For patients on warfarin,  Follow “Suggestions for warfarin management before and after invasive procedures" For patients taking direct oral anticoagulants (DOACs), follow drug-specific recommentations for peri-procedural management Use local methods to prevent or control bleeding

If your doctor has determined you are at special risk of stroke or heart attack, he has likely prescribed a blood thinner (anticoagulant medication). These prescription drugs are very effective at reducing risk for these conditions. However, they do come with a natural side effect of prolonged bleeding. This is of concern when it comes to having any type of surgery, including surgical dental procedures.

Blood thinners work to prevent natural clotting of the blood. This reduces the risk of blood clots forming in blood vessels that can lead to stroke or heart attack. Medications prescribed for this include:

• Aspirin
• NSAIDS (Advil)
• Warfarin (Coumadin and generics)
• Heparin
• Dabigatran Etexilate (Pradaxa)
• Clopidogrel (Plavix)

If you are currently taking any of these medications, please communicate this clearly to your dentist prior to any dental procedures so that proper precautions can be taken. After recording the name and dosage of your medication, your dentist may opt to consult with your cardiologist before prescribing any dental treatment.

Can You Receive Dental Treatment While Taking Blood Thinners?

Patients will be considered for treatment on a case by case basis depending on their personal circumstances. Here are some basic guidelines that most dentists will generally consider.

If your blood thinner is only being taken on a temporary basis, then it is usually practical to delay non-essential dental procedures until the prescription is no longer needed.

If your blood thinner is being taken on a long term basis, usually the dental procedure can still proceed while you continue to take your blood thinners. We never recommend stopping your medication against doctor’s orders as this could put you at risk of stroke or heart attack. Instead, we will take additional steps to control bleeding such as with the use of gauze, hemostatic devices or minimally invasive surgical techniques.

Dental work should be scheduled early in the day and plenty of time for rest after the procedure should be allowed in order to control any bleeding.

Complex Dental Procedures

If a more invasive dental procedure is needed such as a tooth extraction or implant placement, then you, your Auburn family dentist and your cardiologist will need to carefully weigh the potential benefits and risks of temporarily adjusting your blood thinning medication. It’s possible that diagnostic blood tests may be needed to help in making a sound decision.

Most importantly, remember to clearly communicate your current prescription medications with your dentist. This is to help protect your health, and your life!

The team at Rock Creek Family Dentistry is happy to work along with you and your medical healthcare providers to ensure you receive quality dental care that is safe and effective!
Schedule an Appointment

Can you get a tooth pulled while on eliquis?

When should I stop eliquis before tooth extraction?

Do you need to stop blood thinners before tooth extraction?

How many days hold eliquis before procedure?