How long should aspirin (acetylsalicylic acid) be stopped before a dental procedure?

Aspirin Should NOT Be Stopped Before Dental Procedures

Aspirin should be continued without interruption for dental procedures, including extractions, as there is no indication to stop antiplatelet therapy for dental work. 1

Primary Recommendation: Continue Aspirin

The most authoritative guidelines are unequivocal on this point:

• The ACC/AHA explicitly states that "there is no indication to interrupt dual-antiplatelet therapy for dental procedures" 1
• This recommendation applies to both aspirin monotherapy and dual antiplatelet therapy (aspirin plus clopidogrel) 1
• The AHA/ACC/American Dental Association Science Advisory specifically addresses dental procedures, noting that "there is little or no indication to interrupt antiplatelet drugs for dental procedures" 1

Evidence Supporting Continuation

Bleeding Risk is Minimal and Manageable

• A prospective randomized trial of single tooth extractions found no statistically significant difference in postoperative bleeding between patients taking aspirin versus placebo 1, 2
• Multiple studies demonstrate that dental extractions (including multiple teeth) can be safely performed without stopping aspirin, with bleeding controlled by local measures 3, 4
• Oral bleeding is easily controlled with local hemostatic measures such as absorbable gelatin sponges, sutures, and compression 1

Thrombotic Risk Outweighs Bleeding Risk

• The cardiovascular risk of stopping aspirin is substantial, particularly in patients with coronary stents where premature discontinuation can lead to stent thrombosis, myocardial infarction, and death 1
• For patients with drug-eluting stents, stent thrombosis carries a mortality rate of approximately 45% 1
• The ACC/AHA guidelines note that dual antiplatelet therapy increases major bleeding risk by only 0.4% to 1.0% compared to aspirin alone, but this does not apply to dental procedures which are low bleeding risk 1

Practical Management Algorithm

For all dental procedures (cleaning, extractions, periodontal surgery):

1. Continue aspirin at current dose 1
2. Continue clopidogrel if patient is on dual antiplatelet therapy 1
3. Use local hemostatic measures:
   • Absorbable gelatin sponges 1
   • Sutures as needed 1
   • Local compression 4
4. No special timing or discontinuation required 1

Common Pitfalls to Avoid

• Do not routinely instruct patients to stop "blood thinners" before dental work - this outdated practice fails to distinguish between anticoagulants (warfarin) and antiplatelet agents (aspirin/clopidogrel) 1
• Do not delay necessary dental procedures - many procedures can be performed safely or should not be postponed until completion of antiplatelet therapy 1
• Ensure adequate patient education - patients should understand the importance of continuing their antiplatelet therapy and not stopping it on their own 1

Supporting Research Evidence

Recent clinical studies consistently support guideline recommendations:

• A study of 51 patients on low-dose aspirin (75-100 mg daily) undergoing minor oral surgery found no excessive bleeding in any case when aspirin was continued 3
• A comparative study of 130 patients found no statistically significant difference in bleeding between those who continued versus stopped aspirin or clopidogrel 72 hours before extraction 4
• The single randomized controlled trial specifically examining this question (325 mg aspirin daily for 4 days before extraction) demonstrated no difference in oral bleeding time or secondary bleeding outcomes 2

The answer is zero days - do not stop aspirin before dental procedures.