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. The decision to stop aspirin before dental surgery should be made in consultation with both the dentist and the physician who prescribed the aspirin, taking into account the individual patient's risk factors and medical history. Key factors to consider include:
- The type of dental procedure being performed, with more invasive procedures requiring a longer period of aspirin discontinuation
- The patient's underlying medical conditions, such as cardiovascular disease or diabetes, which may affect platelet function and bleeding risk
- The use of other medications that may interact with aspirin or increase the risk of bleeding Aspirin inhibits platelet function by irreversibly blocking cyclooxygenase enzymes, and this effect lasts for the 7-10 day lifespan of affected platelets, which explains the recommended pre-surgical discontinuation period, as discussed in 1. In some cases, such as minor dental procedures like simple extractions or cleanings, aspirin may not need to be discontinued at all, as the risk of bleeding is relatively low, but this decision should be made on a case-by-case basis, considering the individual patient's risk factors and medical history, as noted in 1.
From the Research
Aspirin Discontinuation Before Dental Surgery
- The optimal time to stop Aspirin (Acetylsalicylic Acid) before dental surgery is not universally agreed upon, but studies suggest that it can be stopped 7-10 days before surgery to avoid the risk of increasing blood loss 2.
- However, other studies indicate that the risk of surgical bleeding if antiplatelet drugs are continued is lower than that of coronary thrombosis if they are withdrawn, emphasizing the need for an accurate stratification of the population according to the thrombotic risk 2, 3.
- A study on the recovery time of platelet function after aspirin withdrawal found that platelet reactivity normalized 96 hours after aspirin withdrawal, suggesting that dental extractions may be safely performed 4 days after aspirin withdrawal 4.
- The decision to continue or discontinue aspirin perioperatively should be made on a case-by-case risk-benefit analysis, taking into account the patient's individual risk of thrombotic and bleeding complications 3, 5.
- Patients with established cardiovascular disease but without a coronary stent may likely continue aspirin during the perioperative period unless undergoing closed-space surgery, while patients with a history of coronary stenting likely need aspirin continuation throughout the perioperative period for non-closed space procedures 3.