A common worry before an extraction or implant surgery is what to do about blood-thinning medication. The instinct is to stop it. In most cases that instinct is wrong, and acting on it without advice is more dangerous than the bleeding it was meant to prevent.
Dr. Jin-Ho Cho at Shine Dental Newington — BDS (University of Sydney, 1987), more than 35 years in practice — reviews medication before any surgical procedure. Here is how these medications are actually handled.
Which medications are we talking about?
Two broad groups, and the distinction matters clinically.
Antiplatelet medications reduce the tendency of platelets to clump. Aspirin at low dose is the most common, along with clopidogrel and similar drugs. They are often prescribed after a stent, a heart attack or a stroke.
Anticoagulants interfere with the clotting cascade. This group includes warfarin, and the newer direct oral anticoagulants such as apixaban, rivaroxaban and dabigatran. They are commonly prescribed for atrial fibrillation, deep vein thrombosis, pulmonary embolism or a mechanical heart valve.
Some people take a combination. Some also take supplements — fish oil, high-dose vitamin E, certain herbal preparations — that have a mild effect and are worth mentioning even though they are not prescriptions.
Why is stopping usually not advised?
Because the reason you are taking it has not gone away.
These medications are prescribed to prevent a stroke, a clot or a stent occluding. Pausing them creates a window in which that risk rises. For most routine dental surgery, the bleeding that would be avoided is manageable in the chair, while the clot that might occur is not manageable at all.
Contemporary guidance in Australia and internationally reflects this: for most patients undergoing most dental procedures, anticoagulant and antiplatelet therapy is continued, with local measures used to control bleeding.
The decision is not the dentist's alone to make in either direction. Where a pause is genuinely being considered — for extensive surgery, or where you have particular risk factors — that is discussed with the doctor who prescribed it. Never stop these medications on your own initiative before a dental appointment.
What does your dentist need to know?
- The exact medication and dose, and how long you have taken it.
- Why it was prescribed — the underlying condition affects the calculation.
- Your most recent INR if you take warfarin, ideally taken within 24 to 72 hours of the procedure. This is the standard measure of how thin your blood currently is, and treatment usually proceeds where it sits within the therapeutic range.
- Your prescribing doctor or cardiologist's details.
- Any history of prolonged bleeding after previous dental work, surgery or injury.
- Other medications and supplements, since some interact.
If you take warfarin, ask your doctor whether an INR check close to the appointment is appropriate, and bring the result.
How is bleeding actually managed?
Local measures do most of the work, and they are effective.
Depending on the procedure, these may include careful surgical technique to minimise trauma, packing the socket with a material that supports clot formation, suturing the site, applying firm pressure with gauze, and using a mouthwash or agent that stabilises the clot. Appointments may be scheduled earlier in the day so any bleeding can be reviewed the same day rather than overnight.
You will be given specific post-operative instructions. The ones that matter most: bite firmly on gauze for as long as you are told, avoid rinsing and spitting on the first day, do not smoke, avoid hot food and drink initially, and rest rather than exert yourself. Our dry socket article explains why the clot deserves protecting.
Is bleeding afterwards normal?
Some oozing for several hours is expected after an extraction, and more so on these medications. It usually settles with firm pressure on fresh gauze for a solid twenty minutes without peeking.
Contact the practice if bleeding is brisk rather than oozing, if it continues beyond what you were told to expect, if the clot repeatedly dislodges, or if you feel faint. It is better to call and be reassured than to sit up all night changing gauze.
Does this change whether I can have implants?
Generally not by itself. Implant surgery is planned with the same considerations, and the presence of anticoagulation is a factor to manage rather than a barrier.
What may change is sequencing — for instance, doing fewer sites in one appointment. And where other medical factors sit alongside, the overall assessment may point elsewhere. Our articles on diabetes and implants and osteoporosis medication cover related considerations.
The practical summary
Bring a complete and current medication list. Do not stop anything on your own. If you take warfarin, ask about an INR close to the appointment. Follow the post-operative instructions carefully, because on these medications the local measures matter more.
Individual circumstances vary and every case is assessed on its own facts. Nothing here replaces advice from the doctor who prescribed your medication.
Arranging an appointment
Consultations run in English or Korean. HICAPS on-the-spot claiming is available, and the practice is a CBHS and NIB preferred provider.
Call (02) 9748 4822, mobile 0430 442 018, or send an enquiry.