Post-op Instructions for Patients on
Medications affecting Blood Clotting
Patients taking low-dose Aspirin (75mg - 300mg daily),
Clopidogrel (Plavix), Dipyridamole (Persantin, Persantin
Retard, Asasantin Retard) or are taking Warfarin are at
greater risk of bleeding after teeth have been removed or
after a biopsy has been performed.
Patients taking low-dose Aspirin, Clopidogrel,
Dipyridamole or are taking Warfarin should not have their
medications stopped or altered prior to dental surgical
procedures unless advised otherwise.
If the patient is on Warfarin, the INR is checked on the day
of extraction or biopsy. If the INR is below 3.5 – 4.0, then
the tooth extraction / biopsy can be done.
To minimise bleeding after the tooth extraction / biopsy:
- the socket can be stuffed with various materials that
- the socket is stitched up tightly &
- a mouth rinse containing Tranexamic Acid or
Aminocaproic Acid (this prevents the breakdown of
blood clots) can be prescribed.
- look after the initial clot at the operation site by resting
while the local anæsthetic wears off & the clot fully
forms (2 - 3 hours)
- avoid rinsing the mouth for 24 hours
- not to suck hard or disturb the operation site with the
tongue or any foreign object
- avoid hot liquids and hard foods for the rest of the day
- avoid chewing on the affected side until it is clear that
a stable clot has formed. Care should then be taken
to avoid dislodging the clot
- bleeding continue or restarts, to apply pressure over
the socket using a folded clean handkerchief or gauze
pad. Place the pad over the socket and bite down
firmly for 15 - 20 minutes. If bleeding does not stop,
the Oral Surgeon should be contacted; repacking and
re-stitching of the socket may be required
|Last Updated 26th December 2014
How Should Post-Operative Pain Be Managed?
Patients should follow the advice of their Anticoagulant Clinic with regard to the
choice of painkillers for short-term mild to moderate pain.
Generally, Paracetamol is considered the safest simple painkiller for patients
taking Warfarin and it may be taken in normal doses if pain control is needed and
no contra-indication exists.
Patients should not to take Aspirin, Aspirin-containing compound preparations or
Non-Steroidal Anti-Inflammatory Drugs e.g. Ibuprofen, which are considered less
safe than Paracetamol in patients taking Warfarin.
Patients requiring a course of antibiotics post-operatively should be vigilant for any
signs of increased bleeding.