For a patient with a coronary stent placed in 2016 undergoing a routine dental extraction, how many days should aspirin (ASA) be held?

ASA Should NOT Be Held for Routine Dental Extraction

For a patient with a coronary stent placed in 2016 undergoing routine dental extraction, aspirin should be continued without interruption (0 days held). The stent is now remote (>8 years old), and routine dental extraction is a minor procedure with low bleeding risk that can be safely performed on continued aspirin therapy.

Evidence-Based Rationale

Guideline Recommendations for Stent Patients

The 2016 ACC/AHA guidelines establish that aspirin 75-100 mg daily is recommended indefinitely in patients with prior coronary stent placement 1. The 2024 ESC guidelines similarly recommend lifelong aspirin 75-100 mg daily in chronic coronary syndrome patients with prior PCI 2.

The critical consideration is that your patient's stent was placed in 2016—over 8 years ago—placing them well beyond any high-risk period for stent thrombosis. The French Task Force guidelines note that maintaining aspirin during surgery is the preferred option in patients with drug-eluting stents, irrespective of when the stent was placed 3.

Dental Extraction as a Minor Procedure

The 2022 CHEST guidelines specifically address minor dental procedures, recommending continuation of antiplatelet therapy 4. Multiple research studies demonstrate that:

• Simple dental extractions can be performed safely without stopping aspirin 5, 6, 7, 8
• Mean blood loss during extraction on aspirin is minimal (16.15 ± 3.5 ml) 5
• Any bleeding encountered is easily controlled with local hemostatic measures 6, 7, 8
• The risk of thrombotic complications from stopping aspirin far outweighs the minimal bleeding risk 9

Critical Safety Concern

A case report documents acute myocardial infarction from in-stent thrombosis occurring when aspirin was discontinued for 8 days prior to tooth extraction—even 2 years after stent placement 9. This underscores that stopping aspirin, even for minor procedures and even years after stenting, carries serious cardiovascular risk.

Clinical Algorithm

For your patient:

1. Continue aspirin 75-100 mg daily through the dental extraction
2. Use local hemostatic measures as needed:
   • Pressure pack with gauze for 1 hour post-extraction
   • Suturing of extraction socket
   • Tranexamic acid mouthwash if needed
3. No interruption of aspirin therapy is required or recommended

Common Pitfalls to Avoid

• Do NOT stop aspirin "to be safe" - this actually increases risk of life-threatening cardiovascular events
• Do NOT confuse this with dual antiplatelet therapy (DAPT) - if the patient were also on clopidogrel, that would require different consideration, but aspirin monotherapy should continue
• Do NOT delay the procedure - there is no waiting period needed for a stent placed 8 years ago
• Beware of outdated practices - many dentists still unnecessarily stop aspirin due to overestimation of bleeding risk 10

The evidence consistently supports that routine dental extraction is safe on continued aspirin therapy, and stopping aspirin exposes patients to unnecessary and potentially catastrophic thrombotic risk.