is extraction safe if i take blood thinners

Patients on blood thinners often stop their tablets for a few days before seeing the dentist, thinking it is the safe thing to do. It is not. These medicines protect you from stroke, heart attack or a clot in a stent or heart valve. Stopping them without your physician's advice can be far more dangerous than a little extra bleeding from a tooth socket, which can usually be controlled locally.

Which medicine are you on?

• Antiplatelets, such as aspirin, clopidogrel, prasugrel or ticagrelor. For a routine extraction these are usually continued as normal. Patients on two antiplatelets after a recent stent need extra care, and the timing is discussed with the cardiologist.
• Warfarin or acenocoumarol (common brand names include Acitrom). These are monitored with an INR blood test. Your dentist will want a recent result, usually from within 24 hours of the extraction, or within 72 hours if your INR has been stable. Many guidelines accept routine extractions when the INR is below 4, though the exact figure is a joint decision with your physician.
• Newer anticoagulants, such as rivaroxaban, apixaban or dabigatran. These are not checked with INR. For some extractions, your physician may advise taking the dose after the procedure that day, or missing one morning dose. That decision belongs to your doctor, not to the chemist.

What helps the extraction go smoothly

• Bring a list of all your medicines, with doses, and any recent blood test reports.
• Tell us your diagnosis: heart valve, stent, atrial fibrillation, past stroke or clot. The registration form asks about medicines and medical history.
• Book an early slot if possible. Our Kharadi clinic opens at 8 AM, which leaves the whole day for any bleeding to be noticed and managed.
• If several teeth need removing, your dentist may do them over separate visits.

What your dentist does differently

The extraction is done as gently as possible to limit tissue damage. The socket may be packed with a dissolving material that helps clotting, closed with stitches, and you may be asked to bite on gauze for longer. Some patients are given a tranexamic acid mouthwash to use afterwards. Complex surgical cases are planned with our oral and maxillofacial surgery department.

Aftercare on blood thinners

• Bite firmly on the gauze; our standard aftercare asks for 45 minutes, and your dentist may ask for a repeat.
• No spitting, straws, hot drinks or rinsing for the first 24 hours.
• Avoid painkillers like ibuprofen and diclofenac unless your doctor approves them, as they add to bleeding. Paracetamol is usually preferred.
• Do not restart or change your blood thinner dose except as your physician advised.

When to get help

Some oozing for the first day is normal. If bleeding fills your mouth, or does not slow after 30 to 45 minutes of firm pressure on fresh gauze, call 8484 990 678. Our Kharadi clinic is open until 11 PM. After hours, uncontrolled bleeding needs a hospital emergency department; see our emergency dentist page. To plan an extraction with your medicines in mind, book a consultation and bring your prescriptions along.