Is it necessary to discontinue Acetylsalicylic acid (Aspirin) prior to dental extraction procedures?

From the Guidelines

In most cases, you do not need to stop taking aspirin before dental extractions, as the risk of bleeding complications is generally minimal and manageable with local hemostatic measures, and the potential cardiovascular risks of stopping aspirin typically outweigh the small increased risk of bleeding during dental procedures. Patients on low-dose aspirin therapy (typically 81-325 mg daily) for cardiovascular protection should continue their medication before dental procedures, including extractions, as suggested by the American College of Chest Physicians clinical practice guideline 1. The guideline recommends continuing antiplatelet drugs, such as aspirin, over stopping them before minor dental procedures, due to the very low certainty of evidence regarding the risk of bleeding complications.

Key Considerations

• The risk of bleeding complications from dental extractions while on aspirin is generally minimal and manageable with local hemostatic measures such as pressure, sutures, gelatin sponges, or tranexamic acid rinses.
• The potential cardiovascular risks of stopping aspirin (such as heart attack or stroke) typically outweigh the small increased risk of bleeding during dental procedures.
• If you're taking higher doses of aspirin or multiple blood thinners simultaneously, your dentist might recommend adjustments based on your specific situation and bleeding risk.
• Always inform your dentist about all medications you're taking, including over-the-counter drugs and supplements.
• The dentist and your physician may need to consult on the best approach for your particular medical circumstances, especially if you have additional bleeding disorders or are scheduled for extensive oral surgery, as suggested by the American College of Cardiology/American Heart Association task force on practice guidelines 1.

Additional Guidance

• For patients receiving an antiplatelet drug (ASA or P2Y12 inhibitor) who are undergoing a minor dental procedure, the American College of Chest Physicians clinical practice guideline suggests continuing the antiplatelet drug over stopping the antiplatelet agent before the procedure (Conditional Recommendation, Very Low Certainty of Evidence) 1.
• The French working group on perioperative haemostasis and the French study group on thrombosis and haemostasis also propose that aspirin should not be discontinued preoperatively when prescribed for secondary prevention (cardiovascular prevention, history of ischaemic stroke, lower extremity artery disease), except for procedures with a high risk of bleeding 1.

From the Research

Aspirin Discontinuation Prior to Dental Extraction

• The necessity of discontinuing Acetylsalicylic acid (Aspirin) prior to dental extraction procedures has been studied in several research papers 2, 3, 4, 5, 6.
• Studies have shown that continuing low-dose aspirin therapy during routine dental extraction does not cause clinically significant post-extraction hemorrhage 3.
• Research suggests that there is no indication to discontinue aspirin for persons requiring single-tooth extraction, as the risk of bleeding is not significantly increased 2.
• A study found that although bleeding time was significantly longer when aspirin was continued, it was still within normal limits, and hemostasis control posed no problem 4.
• Recommendations have been developed based on the findings of these reviews, stating that it is not necessary to interrupt low-dose aspirin therapy (100 mg/day or less) for simple dental extractions 6.

Bleeding Risks and Aspirin Therapy

• The fear of uncontrolled bleeding often prompts medical and dental practitioners to stop aspirin intake for 7 to 10 days before any surgical procedure, which puts the patient at risk from adverse thrombotic events 3.
• However, studies have shown that the total study population had a mean blood loss of 16.15 ± 3.5 ml, and 87% of patients had mild bleeding (<20 ml) 3.
• The risk of prolonged bleeding if anticoagulant therapy is continued is outweighed by the morbidity of potential thromboembolic events if anticoagulant therapy is discontinued 6.

Clinical Recommendations

• Aspirin intake can be continued during routine dental extraction as post-extraction bleeding encountered will be negligible 3.
• Clinicians should use their judgment, experience, training, and accessibility to appropriate bleeding management strategies when deciding whether to modify or discontinue warfarin therapy for simple dental extractions 6.
• A 2-day regimen of postoperative 4.8% tranexamic acid mouthwash is beneficial after oral surgical procedures in patients on warfarin 6.