Do you need to stop anticoagulants before a tooth extraction?
Do not stop anticoagulant or antiplatelet medicines on your own before a tooth extraction: the decision is made by your doctor or the dentist. The Scottish SDCEP guidance of 2022 recommends that most dental procedures, including the simple extraction of 1 to 3 teeth, are carried out without interrupting these medicines.
The reason is simple. Interrupting a medicine that protects against clots raises the risk of a stroke or an embolism, while bleeding after a tooth extraction can usually be controlled locally: with pressure, haemostatic material in the socket and stitches.
The SDCEP leaflet for patients puts it in one sentence: do not change your anticoagulant or antiplatelet medicine because of dental treatment unless your doctor, specialist or dentist tells you to. This applies particularly to people with a mechanical heart valve or a coronary artery stent, those who have had a pulmonary embolism or deep vein thrombosis in the last 3 months, and those being prepared for cardioversion: for them the guidance rules out any pause without written advice from a cardiologist.
Which blood-thinning medicines matter at the dentist?
In everyday speech they are all called blood thinners, but they work in different ways and the dentist handles them differently. Some patients do not know that their medicine belongs to this group, so it is worth checking the name of the active substance on the packet.
- Vitamin K antagonists: warfarin and acenocoumarol; the strength of their effect is measured with an INR test.
- Direct oral anticoagulants (DOACs): apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto) and edoxaban (Lixiana).
- Low molecular weight heparins given by injection, for example enoxaparin (Clexane) and dalteparin (Fragmin).
- Antiplatelet medicines: acetylsalicylic acid (for example Acard), clopidogrel, prasugrel and ticagrelor, taken alone or in pairs.
- Products that can increase bleeding: non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac, and among herbal remedies St John’s wort, ginkgo and garlic.
What does the SDCEP guidance recommend for each group of medicines?
The table summarises the 2022 SDCEP recommendations, without doses. It describes general principles, not instructions: the specific plan is set by your doctor and the dentist, who know the reason for your treatment and the scope of the procedure.
| Group of medicines | What the SDCEP guidance recommends | What is taken into account |
|---|---|---|
| Warfarin, acenocoumarol | With an INR below 4, treatment without interrupting the medicine | With an INR of 4 or higher, a planned procedure is postponed |
| DOAC, low-risk procedure | Treatment without interrupting the medicine | A morning appointment, limited scope, stitches and a dressing |
| DOAC, higher-risk procedure | Change in the timing of the morning dose, only on the dentist’s advice | The dentist says when to restart the medicine after the procedure |
| Heparin by injection | At a preventive dose, treatment without interruption | At a treatment dose, consultation with a doctor |
| One antiplatelet medicine | Treatment without interrupting the medicine | With medicines other than aspirin alone, bleeding lasts longer |
| Two antiplatelet medicines | Treatment without interrupting the medicines | Bleeding may last up to an hour; higher risk |
| Anticoagulant with an antiplatelet | No pause, unless a cardiologist advises otherwise in writing | With short-term therapy, a planned procedure can be postponed |
Which dental procedures carry a higher risk of bleeding?
The SDCEP guidance divides procedures into three groups, because this determines whether anything needs to change at all. Most everyday dental treatment falls into the first two.
The cardiology recommendations of the European Heart Rhythm Association (EHRA, 2021) also classify the extraction of 1 to 3 teeth, periodontal procedures and implant placement as procedures with a low risk of bleeding, but they propose a slightly different scheme for DOACs than SDCEP does. This is one more reason for the plan to be set by your doctor together with the dentist, not by the patient.
| Bleeding risk | Examples of procedures according to SDCEP |
|---|---|
| Bleeding unlikely | Infiltration anaesthesia, root canal treatment, fillings above the gum, impressions |
| Low risk of complications | Simple extraction of 1 to 3 teeth, incision of an abscess, root cleaning below the gum |
| Higher risk of complications | Complex extractions, more than 3 teeth at once, flap procedures, implants, biopsies |
Acard before a tooth extraction: what the leaflet says and what the guidelines say
The leaflet for Acard (acetylsalicylic acid, the active substance of aspirin) says not to take it for at least 5 days before a planned surgical procedure, including a minor one such as a tooth extraction. The 2022 SDCEP guidance, by contrast, recommends that patients taking one or two antiplatelet medicines are treated without interrupting them (a strong recommendation, low certainty evidence).
This discrepancy is not an invitation to decide for yourself, but a reason to talk to the doctor who prescribed the medicine. The guidance points out that interrupting antiplatelet treatment carries a higher risk of thromboembolic complications, and in people with a coronary artery stent it threatens serious cardiac complications.
If you take acetylsalicylic acid without a doctor’s advice, tell your dentist about it just as you would about a prescription medicine. SDCEP notes that many patients take aspirin or other anti-inflammatory medicines without a prescription, and this too increases the risk of bleeding.
Warfarin and the dentist: why does the INR result matter?
With warfarin and acenocoumarol, the dentist relies on the INR result, which shows how strongly the medicine inhibits clotting. According to SDCEP, with an INR below 4 the procedure is carried out without interrupting the medicine, and the result should ideally come from the 24 hours before the procedure; for people with a stable INR, a test taken up to 72 hours earlier is enough.
If the INR is 4 or more, a planned procedure is postponed, and urgent treatment is moved to a hospital setting. Bring your anticoagulation booklet or a printout of your latest INR results to the visit.
Warfarin interacts with some of the medicines used in dentistry; SDCEP mentions, for example, metronidazole, which markedly strengthens its effect. That is why the dentist needs to know the full list of your medicines before prescribing anything.
Xarelto, Eliquis and other DOACs before an extraction: who sets the plan?
With medicines from the DOAC group, such as Xarelto or Eliquis, the SDCEP guidance recommends carrying out procedures with a low risk of bleeding, including the simple extraction of 1 to 3 teeth, without interrupting the medicine. The procedure is then scheduled early in the day, with a limited scope and stitches.
For higher-risk procedures, for example several extractions at once or the placement of an implant, the guidance allows the dentist to advise skipping or delaying the morning dose on the day of the procedure and to say when to restart the medicine. This is a decision for the dentist and your doctor, given to the patient directly, not something done on your own after reading an article.
What should you tell the dentist, and how is bleeding controlled after the procedure?
The dentist needs to know all your medicines and conditions; the SDCEP leaflet puts this rule first. The information worth passing on before the procedure is gathered in the list below.
During the procedure, the dentist works as conservatively as possible, packs the socket with haemostatic material and places stitches, and the patient leaves only once the bleeding has stopped. For pain relief the guidance recommends paracetamol, if there are no contraindications, rather than non-steroidal anti-inflammatory drugs, which can increase bleeding.
After the procedure, bite on a damp gauze pad for 15 to 20 minutes without checking it every few moments, and do not rinse your mouth for 24 hours; pink-tinged saliva for 1 to 2 days is normal. If bleeding does not stop despite 15 to 20 minutes of firm pressure, contact the surgery, and in the case of sudden, heavy bleeding that cannot be controlled, call 112, the emergency number, or go to a hospital emergency department (SOR).
- The name of your anticoagulant or antiplatelet medicine and the reason you take it.
- Whether the treatment is long-term or for a set period; with short-term therapy a planned procedure can sometimes be postponed until it ends.
- Your latest INR results, if you take warfarin or acenocoumarol.
- All your other medicines, including over-the-counter ones, as well as herbal remedies and supplements.
- Kidney, liver and blood disorders and cancers, because they can increase bleeding.
- Whether bleeding after a procedure, injury or cut has ever lasted a very long time or needed hospital care.
How it works at DentalBlue
At DentalBlue in Białystok, surgical procedures, including extractions, are carried out under local anaesthesia or, for patients who qualify, under general anaesthesia. It is worth bringing a list of all your medicines to the consultation, and, if you take warfarin or acenocoumarol, a current INR result. In the clinic’s price list, a simple extraction of a single-rooted permanent tooth costs 350 zł, of a multi-rooted one 500 zł, and a socket revision with stitches 200 zł. The final scope and cost are set at the consultation, and prices may change. A consultation can be booked by phone.
Frequently asked questions
Can you have a professional cleaning while taking anticoagulants?
Yes. The SDCEP leaflet stresses that people taking these medicines should keep brushing as usual and keep seeing the dentist and hygienist, because with poor hygiene the gums bleed more easily. The guidance places tartar removal above the gum among procedures where bleeding is unlikely.
Is a dental anaesthetic safe with blood-thinning medicines?
The SDCEP guidance places infiltration anaesthesia among procedures where bleeding is unlikely. For a nerve block in the lower jaw there is no evidence of a significant risk of bleeding, but if your INR is unstable the dentist may ask for a current result before the procedure.
Can you have an implant while taking anticoagulants?
The SDCEP guidance classifies implant placement as a higher-risk procedure for bleeding and describes how to plan it in that case. The plan, including any change in the timing of a DOAC dose, is set by the dentist and your doctor; the medicine is not stopped on your own.
What if I am only taking an anticoagulant for a few weeks?
Tell your dentist. For treatment over a set period, the SDCEP guidance recommends, where possible, postponing planned procedures that may cause bleeding until the treatment has finished. Urgent treatment, for example of an abscess, is not put off.
Can the dentist change my anticoagulant themselves?
According to the guidance, the dentist may advise changing the timing of one dose of a DOAC before a higher-risk procedure. For people with a stent, a mechanical valve or a recent thrombosis, a pause in treatment requires written advice from a cardiologist. In every case the change is set by a doctor or dentist, not by the patient.
Sources
- SDCEP: Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd edition (2022)
- SDCEP: Anticoagulant or antiplatelet medication and your dental treatment, patient leaflet (2022)
- Polpharma: Acard 75 mg, patient leaflet (2025)
- Steffel J et al., Europace: EHRA practical guide on the use of DOACs (2021)
- Bristol Dental School: Advice after dental extractions and surgical procedures, patient leaflet (undated)
An informational article. It does not replace a consultation, and treatment decisions are made during a visit.
