Aspirin Should NOT Be Discontinued Before 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, 2
Evidence-Based Rationale
The strongest evidence comes from multiple major cardiology and dental societies that jointly recommend continuation of aspirin:
The American Heart Association, American College of Cardiology, American Dental Association, and American College of Surgeons explicitly state there is little or no indication to interrupt antiplatelet drugs, including aspirin, for dental procedures. 1, 2
The ACC/AHA 2007 guidelines specifically note that "there is no indication to interrupt dual-antiplatelet therapy for dental procedures" and that aspirin monotherapy carries even less bleeding risk. 1
A prospective randomized controlled trial of 36 patients found no statistically significant difference in postoperative bleeding between patients taking 325 mg/day aspirin versus placebo after single tooth extraction. 3, 4
Multiple observational studies confirm no well-documented cases of clinically significant bleeding after dental extractions in patients on aspirin therapy. 1, 5, 6
Clinical Algorithm for Management
For patients on aspirin for cardiovascular disease:
- Continue aspirin at the current dose without interruption 1, 2
- Inform the patient that continuing aspirin is safer than stopping it 2
- Perform the extraction using standard technique 5, 6
For patients with coronary stents (especially drug-eluting stents):
- Aspirin must be continued due to the catastrophic risk of stent thrombosis, which frequently leads to MI and/or death 1
- Even if on dual antiplatelet therapy (aspirin + clopidogrel/ticagrelor), both agents should ideally be continued 1, 2
Local hemostatic measures are highly effective:
- Have absorbable gelatin sponge and sutures readily available 1, 2
- Consider tranexamic acid rinse if needed 2
- These measures easily control any minor bleeding that may occur 1
Why This Recommendation Differs from Other Surgeries
The French guidelines recommend 3-5 days of aspirin discontinuation before high-risk bleeding procedures like neurosurgery 1, but dental extractions are explicitly excluded from this category because:
- The oral cavity allows direct visualization and easy access for hemostatic control 1
- Bleeding can be managed with simple local measures (pressure, sutures, hemostatic agents) 1, 2
- Once an initial clot forms, bleeding is unlikely to recur 1
- The bleeding risk is minimal compared to the thrombotic risk of aspirin discontinuation 1
Common Pitfalls to Avoid
Do not routinely instruct patients to stop "blood thinners" without distinguishing between warfarin and antiplatelet agents - this is a common error that puts patients at unnecessary thrombotic risk. 1
Do not confuse aspirin management for dental procedures with management for closed-space surgeries (like neurosurgery or posterior chamber eye surgery), where aspirin should be stopped 5 days beforehand. 1, 7
Do not use "bridging" with other anticoagulants - there is no evidence of benefit from warfarin or glycoprotein IIb/IIIa agents, and they increase bleeding risk. 1
Post-Operative Instructions
Provide clear instructions about what constitutes abnormal bleeding and when to seek care, as patients on aspirin may have slightly prolonged bleeding time even though clinically significant bleeding is rare. 2, 6