2024.09.10
Blood thinners are medications that help your blood flow smoothly through your veins and arteries. Your doctor may prescribe a blood thinner to help prevent heart attacks and strokes, if you are at risk. The two most common categories of blood thinners are antiplatelet drugs and anticoagulants. They both work at different places in the coagulation system.
Anticoagulants
Warfarin (Coumadin) is an oral anticoagulant which works by preventing the formation of vitamin K-dependent clotting factors. Patients on Warfarin, typically get their blood tested routinely to ensure their International Normalized Ratio (INR) is within the therapeutic range. During your visit with us, we may ask about your most recent INR before providing any invasive dental care. According to the literature, moderately invasive surgery (e.g. uncomplicated tooth extractions) are safe with an INR up to 3.5.
Direct acting oral anticoagulants (DOAC) are now more common than Warfarin. They directly inhibit specific proteins in blood clotting. Compared to Warfarin, DOAC’s are safer, more effective, cause less serious bleeding, do not require diet restrictions and do not require frequent lab tests to check INR. There are four common DOACs available in Canada:
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
- Dabigatran (Pradaxa)
- Edoxaban (Liixiana)
Antiplatelets
Antiplatelets prevent platelets from sticking together and forming a blood clot. According to the Heart and Stroke Foundation, most people who have had a cardiac event take an antiplatelet drug. Common antiplatelets medications are:
- ASA, Aspirin
- Clopidogrel (Plavix)
- Ticagrelor (Brilinta)
- Prasugrel (Effient)
Modifications to Treatment
It is recommended to continue low-dose aspirin with invasive dental treatment.
If you are on a blood thinner other than low-dose aspirin, the following are recommended:
- We may have you follow up with your Family Physician, if we are concerned about excessive bleeding during the procedure. We may also ask for INR results or try to coordinate lab results with your Family Physician.
- We may time the procedure so it is not performed soon after taking the medication. It is recommended that you wait 12 hours after taking the blood thinner before receiving invasive care.
- We will manage the bleeding during the procedure using pressure and gauze, sutures, and other medical means.
- We may also stage your procedures into multiple appointments to reduce the risk of post-operative bleeding.
If your bleeding continues after the dental procedure, whereby firm pressure and gauze is not working, it is an emergency. Please contact us immediately and we will guide you with how to manage the incident.