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
platelets 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 the
clot.  Warfarin can only affect these blood proteins when they are being made.
Useful Website:

Scottish Dental Clinical Effectiveness Programme

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

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