Do I need to stop Plavix (clopidogrel) prior to dental extractions?

From the Guidelines

You generally do not need to stop taking Plavix (clopidogrel) before dental extractions, as the risk of serious bleeding complications during dental work is typically low and manageable with local measures, while stopping Plavix could increase your risk of dangerous cardiovascular events like heart attack or stroke 1. Most dental procedures, including extractions, can be safely performed while continuing Plavix therapy.

Before your procedure, inform your dentist that you take Plavix so they can prepare appropriate hemostatic measures such as gelatin sponges, sutures, or tranexamic acid mouthwash if needed. Your dentist may also schedule your appointment earlier in the day to allow time to manage any bleeding issues.

• Key considerations include:
  • Balancing the risk of bleeding against the more serious risk of thrombotic events that could occur if Plavix is discontinued
  • Informing your dentist about Plavix use to ensure they are prepared for the procedure
  • Potential use of local hemostatic measures to manage bleeding
• In some complex cases involving multiple extractions or oral surgery, your dentist and cardiologist might discuss temporarily adjusting your medication, but this decision should never be made without consulting both healthcare providers 1. The American College of Chest Physicians suggests continuing antiplatelet drugs like Plavix for minor dental procedures, based on a conditional recommendation with very low certainty of evidence 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.

You should talk to your doctor about stopping Plavix (clopidogrel) before dental extractions. Your doctor may advise you to stop taking clopidogrel at least 5 days before the procedure to minimize the risk of excessive bleeding. However, the decision to stop clopidogrel should be made on a case-by-case basis, considering the individual's risk of bleeding and the potential consequences of stopping the medication 2, 2.

From the Research

Stopping Plavix Before Dental Extractions

• The decision to stop Plavix (clopidogrel) before dental extractions depends on various factors, including the patient's medical history and the type of extraction being performed 3, 4, 5, 6, 7.
• Studies have shown that the risk of bleeding after dental extractions in patients taking antiplatelet drugs, including Plavix, is relatively low 5, 6, 7.
• A study published in 2018 found that discontinuation of antiplatelet treatment four or more days before tooth extraction was a protective factor against postoperative bleeding, but also emphasized the need to assess the thrombotic risk associated with interrupting antiplatelet drugs 3.
• Another study published in 2021 found no statistically significant differences in post-extraction bleeding between patients who stopped antiplatelet therapy and those who continued it, suggesting that dental extractions can be performed without interrupting antiplatelet drugs 4.
• Other studies have also found that continuing antiplatelet therapy, including Plavix, during dental extractions does not significantly increase the risk of bleeding 5, 6, 7.
• Local hemostatic measures, such as gauze pressure packs or suturing, can be effective in controlling bleeding in patients taking antiplatelet drugs, including Plavix 4, 6, 7.

Key Findings

• No significant differences in bleeding risk between patients who continued or stopped antiplatelet therapy, including Plavix, before dental extractions 4, 5, 6, 7.
• Discontinuation of antiplatelet treatment four or more days before tooth extraction may be a protective factor against postoperative bleeding, but thrombotic risk must be assessed 3.
• Local hemostatic measures can be effective in controlling bleeding in patients taking antiplatelet drugs, including Plavix 4, 6, 7.

Considerations for Dental Extractions

• Patients taking Plavix should consult with their physician and dentist to determine the best course of action before dental extractions 3, 4, 5, 6, 7.
• A thorough medical history, physician's consent, and coagulation profile should be obtained before performing dental extractions in patients taking antiplatelet drugs, including Plavix 4.
• Local hemostatic measures should be used to control bleeding in patients taking antiplatelet drugs, including Plavix 4, 6, 7.