Should aspirin (acetylsalicylic acid) be discontinued before a dental extraction?

Aspirin Should NOT Be Discontinued for Dental Extraction

Aspirin should be continued for routine dental extractions, as the risk of thrombotic complications from discontinuation far outweighs the minimal and manageable bleeding risk associated with the procedure. 1

Evidence-Based Rationale

Bleeding Risk is Minimal and Manageable

• A prospective randomized controlled trial of single tooth extractions comparing aspirin (325 mg/day) versus placebo found no statistically significant difference in postoperative bleeding between groups 1, 2

• Multiple studies confirm that dental extractions—including multiple extractions—have no well-documented cases of clinically significant bleeding in patients on aspirin therapy 1

• Local hemostatic measures (absorbable gelatin sponge, sutures) are highly effective at controlling any minor bleeding that may occur during dental procedures 1

• A 2017 study of 80 patients on low-dose aspirin found that only 1 patient required local hemostatic measures, with no episodes of prolonged postoperative bleeding 3

Thrombotic Risk of Discontinuation is Catastrophic

• Premature discontinuation of antiplatelet therapy markedly increases the risk of stent thrombosis, a catastrophic event that frequently leads to MI and/or death 1

• The American Heart Association, American College of Cardiology, American Dental Association, and American College of Surgeons jointly state that there is little or no indication to interrupt antiplatelet drugs for dental procedures 1

• Many patients are inappropriately instructed to stop "blood thinners" before dental procedures due to misguided concerns about excessive procedure-related bleeding 1

Clinical Algorithm for Decision-Making

Step 1: Identify the Indication for Aspirin

• Cardiovascular disease prevention (especially with coronary stents): Continue aspirin—discontinuation poses unacceptable thrombotic risk 1

• Primary prevention in low-risk patients: Continue aspirin—bleeding risk remains minimal 2, 3

Step 2: Assess the Dental Procedure

• Routine dental extractions (single or multiple teeth): Continue aspirin 1, 2, 3

• Teeth cleaning and minor dental procedures: Continue aspirin 1

Step 3: Plan Local Hemostatic Measures

• Use absorbable gelatin sponge at extraction site 1

• Place sutures as needed for hemostasis 1

• Apply local pressure and ensure initial clot formation before patient discharge 1

Important Caveats and Pitfalls

Common Pitfall: Confusing Aspirin with Warfarin

• Healthcare providers often fail to distinguish between warfarin (which may require adjustment) and antiplatelet agents like aspirin (which should be continued) 1

• Aspirin and warfarin have fundamentally different risk-benefit profiles for dental procedures 1

Special Consideration: Patients with Coronary Stents

• For patients on dual antiplatelet therapy (aspirin + clopidogrel/ticlopidine), both agents should ideally be continued for dental procedures 1

• If a thienopyridine must be stopped for major surgery, aspirin should be continued to mitigate stent thrombosis risk 1

When Aspirin Might Be Stopped (Rare Exceptions)

• The ACC/AHA guidelines note that aspirin monotherapy need not be routinely discontinued for elective noncardiac surgery, with possible exceptions being intracranial surgery and prostatectomy—but dental extraction is not among these exceptions 1

• The 2025 guidelines specify that aspirin should be discontinued 5 days before procedures "in a confined space (brain, posterior chamber of the eye, medullary canal)"—dental extraction is not a confined space procedure 4

Practical Management

• Inform the patient that continuing aspirin is safer than stopping it 1

• Perform atraumatic extraction technique to minimize tissue trauma 3

• Have local hemostatic agents readily available (gelatin sponge, sutures, tranexamic acid rinse if needed) 1

• Provide clear post-operative instructions about what constitutes abnormal bleeding and when to seek care 2, 3