Anti-Platelet Drugs & Oral Surgery
An increasing number of patients are taking “blood thinners
for various medical conditions.

These drugs interfere with the body’s normal clotting
mechanism. There are 2 main processes by which the body
normally forms a
blood clot at the site of tissue injury.

The 1st involves small blood cells called
platelets which
clump together at the wound to form a mechanical
plug. This
plug slows the flow of blood through the vessel and forms a
matrix for the next phase of
coagulation. During coagulation,
chemicals in the blood interact with each other to fill in the
spaces between the
platelets, stabilise the clot, & make it
more solid until the process stops the bleeding.

Anti-platelet drugs such as
aspirin, ticlopidine & clopidogrel
target this phase of
clot formation by preventing platelets
from sticking together and adhering to blood vessels. These
drugs do this by creating permanent changes in the
which last for the lifetime of the
platelet (7 - 10 days). These
effects can only be countered as the body produces new
platelets that have not been exposed to the drug.

Anti-coagulant agents such as
warfarin inhibit the 2nd phase
of clotting by blocking production of proteins that stabilise
clot.  Warfarin can only affect these blood proteins when
they are being made.
Useful Articles:

BDJ 2003.  Dental Management Considerations for the Patient with an Acquired
Coagulopathy.  Part 2. Coagulopathies from Drugs

American Academy of Oral Medicine 2007. Patient Information Sheet.  Blood
Thinners Dental Care

J Oral Sciences 2007.  Dental Management of patients recieving anti-coagulation
or anti-platelet treatment

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007.  Management of Dental
Patients taking Common Hemostasis-Altering Medications

Evidence-Based Dentistry 2008.  Guidelines for the Management of Patients who
are taking Oral Anticoagulants & who require Dental Surgery

JOMS 2011.  Delayed Complications of Tooth Extraction in Patients Taking
Warfarin, Antibiotics and Other Medications

JOMS 2011.  Risk Factors Affecting Postoperative Hemorrhage After Tooth
Extraction in Patients Receiving Oral Antithrombotic Therapy

BJOMS 2012.  Safety of local anaesthesia in dental patients taking oral
anticoagulants.  Is it still controversial

Dent Update 2013. Special Care Dentistry Part 2.  Dental Management of Patients
with Drug-Related Acquired Bleeding Disorders

Dental Update 2014.  Haemostasis Part 2.  Medications that Affect Haemostasis
Last Updated 20th May 2015