How long before dental surgery should Aspirin (Acetylsalicylic Acid) be stopped?

From the Guidelines

Aspirin should be stopped at least 5 days before dental surgery to minimize the risk of bleeding, as recommended by the French Haute Autorité de la santé (HAS) and supported by studies such as 1. When considering the management of antiplatelet therapy in patients undergoing elective invasive procedures like dental surgery, it's crucial to balance the risk of bleeding against the risk of stopping aspirin in patients taking it for cardiovascular protection.

• The time required for the full recovery of thromboxane A2 synthesis, which is inhibited by aspirin, is about 10 days, but recovery does not need to be total for the complete correction of the platelet functions that depend on thromboxane A2 synthesis 1.
• Interindividual variability in correction of platelet function explains why not all subjects have complete correction after four days, and the association between results of platelet function tests and bleeding risk is not straightforward 1.
• For procedures with a high risk of bleeding, a five-day washout of aspirin is proposed to completely correct the platelet functions inhibited by aspirin, as suggested by 1.
• Patients should never discontinue aspirin without consulting both their dentist and the physician who prescribed it, especially for those at high risk of thrombotic events, where stopping aspirin may be more dangerous than the bleeding risk from dental surgery.
• After dental surgery, aspirin can typically be resumed within 24-48 hours once adequate hemostasis is achieved, but this should be determined on a case-by-case basis, considering the individual patient's risk factors and the specific procedure performed.

From the Research

Aspirin Management Before Dental Surgery

• The decision to stop aspirin before dental surgery depends on various factors, including the patient's cardiovascular risk and the type of surgery being performed 2.
• Studies suggest that aspirin can be continued in patients undergoing routine dental extraction, as the risk of bleeding is not significantly increased 3, 4.
• However, in patients with high cardiovascular risk or those undergoing more complex surgeries, the decision to stop aspirin should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 2, 5.
• Some studies recommend stopping aspirin 7-10 days before surgery to minimize the risk of bleeding complications, while others suggest that aspirin can be safely continued in patients undergoing dental extraction 3, 5.

Bleeding Risks Associated with Aspirin Use

• The risk of bleeding after dental extraction in patients taking aspirin is generally considered to be low, with most studies reporting minimal bleeding complications 3, 4, 6.
• However, the risk of bleeding may be increased in patients taking aspirin in combination with other antiplatelet medications, such as clopidogrel 6.
• The timing of the last dose of aspirin may also impact the risk of bleeding, with one study suggesting that bleeding risk is increased if aspirin is taken within 20 hours of surgery 6.

Clinical Guidelines and Recommendations

• Clinical guidelines recommend that patients taking aspirin for primary prevention of cardiovascular disease should likely discontinue it during the perioperative period, especially when there is a high risk of bleeding 2.
• However, patients with established cardiovascular disease may need to continue aspirin throughout the perioperative period, unless undergoing closed-space surgery 2.
• Ultimately, the decision to stop or continue aspirin before dental surgery should be made in consultation with the patient's healthcare provider, taking into account their individual risk factors and medical history 2, 5.