From the Guidelines
Patients taking Plavix (clopidogrel) should stop taking it at least 5 days before a dental extraction. This recommendation is based on the guidelines for coronary artery bypass graft surgery, which suggest discontinuing clopidogrel for at least 5 days before surgery to limit blood transfusions 1. When considering dental extraction, the risk of bleeding must be balanced against the risk of thrombotic events in patients taking Plavix.
- The decision to discontinue Plavix should involve consultation between the dentist and the prescribing physician, usually a cardiologist.
- For patients with a high risk of bleeding or those undergoing more complex dental procedures, a longer discontinuation period may be considered.
- Local hemostatic measures like pressure, sutures, and hemostatic agents can help manage bleeding during and after the procedure for patients who must remain on antiplatelet therapy.
- After the extraction, patients can usually resume Plavix within 24 hours once stable clot formation has occurred, but this should be determined on a case-by-case basis considering the patient's overall medical condition and the specific procedure performed.
- It's also important to note that for minor dental procedures with minimal bleeding risk, some patients may continue Plavix without interruption, as the risk of stopping the medication may outweigh the benefits of discontinuing it 1.
From the FDA Drug Label
Talk with your doctor about stopping your clopidogrel tablets before you have surgery. Your doctor may tell you to stop taking clopidogrel tablets at least 5 days before you have surgery to avoid excessive bleeding during surgery.
The patient should stop taking Plavix (clopidogrel) at least 5 days before a dental extraction to minimize the risk of excessive bleeding. 2
From the Research
Stopping Plavix Before Dental Extraction
The decision to stop Plavix (clopidogrel) before a dental extraction depends on various factors, including the patient's medical history and the type of procedure. Here are some key points to consider:
- The risk of bleeding after dental extraction in patients taking Plavix is a concern, but studies suggest that the risk is relatively low 3, 4.
- One study found that stopping Plavix 5 days before extraction did not significantly reduce the risk of bleeding compared to continuing the medication 4.
- Another study suggested that discontinuing antiplatelet treatment 4 or more days before extraction may be a protective factor against bleeding, but this should be weighed against the risk of thrombotic events 5.
- The American Heart Association and other organizations recommend continuing antiplatelet therapy, including Plavix, in patients undergoing dental procedures, unless there is a high risk of bleeding 6.
Recommendations
Based on the available evidence, here are some recommendations:
- Patients taking Plavix should consult their doctor or dentist before stopping the medication for a dental extraction 3, 4.
- The decision to stop Plavix should be made on a case-by-case basis, taking into account the patient's medical history and the type of procedure 5, 6.
- Local hemostatic methods, such as gauze pressure pack or other local hemostatic agents, can be effective in controlling bleeding during and after dental extraction 4, 6.
Key Findings
Some key findings from the studies include:
- No significant differences in bleeding risk were found between patients who stopped Plavix 5 days before extraction and those who continued the medication 4.
- Discontinuing antiplatelet treatment 4 or more days before extraction may be a protective factor against bleeding, but this should be weighed against the risk of thrombotic events 5.
- Local hemostatic methods can be effective in controlling bleeding during and after dental extraction 4, 6.