From the Guidelines
It is recommended to hold aspirin for 5 days before a dental procedure, as this allows for the restoration of normal platelet function and minimizes the risk of bleeding, according to the most recent and highest quality study 1. When considering the management of antiplatelet therapy in the context of dental procedures, it's essential to weigh the risks of bleeding against the risks of thrombotic events.
- The American College of Chest Physicians suggests continuing antiplatelet therapy perioperatively in patients with a coronary stent who require surgery, rather than stopping it 7 to 10 days before surgery 1.
- However, for patients at low risk of cardiovascular events having major surgery, aspirin should be discontinued 5 days before the procedure, as stated in the aagbi guidelines 1.
- The decision to stop aspirin before a dental procedure should be made on a case-by-case basis, taking into account the individual's medical history and the specific procedure being performed.
- It's crucial to consult with the patient's physician before making any changes to their medication regimen, especially if they are taking aspirin for a medical condition like heart disease or stroke prevention.
- Informing the dentist about all medications being taken, including over-the-counter drugs like aspirin, is also vital to ensure the best possible outcome.
- Aspirin's effect on platelet aggregation persists for the lifespan of the affected platelets, which is approximately 7-10 days, supporting the recommendation to hold aspirin for 5 days before a dental procedure 1.
From the Research
Aspirin Intake Before Dental Procedures
- The fear of uncontrolled bleeding often prompts medical practitioners to stop aspirin intake for seven to 10 days before any surgical procedure 2.
- However, studies suggest that low-dose aspirin therapy should not be stopped before oral surgery, as local hemostasis is sufficient to control bleeding 2, 3, 4, 5.
- In fact, stopping aspirin therapy may put patients at risk of adverse thrombotic events 2, 3, 5.
Bleeding Risk with Continued Aspirin Therapy
- The overall frequency of postoperative bleeding in patients taking aspirin was found to be 3.2% to 4.9% 4, 5.
- None of the patients experienced prolonged bleeding, and local hemostasis was sufficient to control bleeding 2, 4, 5.
- No statistically significant difference in bleeding was found between patients who continued aspirin therapy and those who stopped it before dental extractions 5.
Recommendations for Dental Procedures
- Antiplatelet medications, including aspirin, should not be interrupted for tooth extractions or minor oral surgery 2, 3, 4, 5.
- Local measures, such as gelatine sponge and/or suturing, are sufficient to control bleeding in patients taking aspirin 5.
- Dentists should be aware of the potential risks and benefits of continuing or stopping aspirin therapy before dental procedures 6.