Ischemic Attack Fo

Should you stop anticoagulants before surgery?

June 7, 2013
Patients who take anticoagulants need to decide whether or not to taken them during surgery or other dental or medical procedures. Maria Perno Goldie, RDH, MS, explores this issue and suggests that a thorough medical health history of the patient will help determine the best treatment plan.

New guidelines from the American Academy of Neurology will assist us when we have patients taking anticoagulants. They often need to decide whether or not to take them during surgery or other dental or medical procedures. The guideline has recently been published.(1)

People who have had a transient ischemic attack (TIA) or stroke are frequently prescribed anticoagulants to thin their blood, such as aspirin or warfarin, as a preventive measure. Anticlotting drugs are sometimes used to prevent an initial stroke in people with atrial fibrillation, an irregular or fast heartbeat. Anticlotting drugs can prevent blood clots from forming, but a negative side effect can be the risk of bleeding. Increased bleeding is a concern when someone is having a surgical procedure, and in our world, extractions or periodontal surgery.
According to the study authors, there could be millions of people taking anticlotting drugs for preventive purposes. It is advised that patients discuss with their healthcare provider if the medication should be temporarily stopped for dental or medical procedure. The rationale for temporarily stoppage is to lower the risk of bleeding with the procedure. That needs to be weighed against the increased risk of stroke or other medical issues. The risk of bleeding varies depending on the procedure. For many minor procedures, including dental procedures, the bleeding risk from continuing blood thinners is fairly small.(2) For procedures like some hip and colon procedures, the risk of bleeding could be higher if a patient continues to take their prescribed anticoagulants.

The guideline, based on current evidence, is a kind of decision tree for patients and healthcare providers to determine the benefits and risks involved with stopping the medication. As always, a thorough medical health history will help to determine the best treatment plan.

Most of the studies on bleeding risks from anticlotting drugs during procedures center on aspirin and warfarin. As always, more studies are needed to understand the bleeding risks of other blood thinners, such as clopidogrel and aspirin plus dipyridamole, as well as new anticoagulants such as dabigatran, rivaroxaban or apixaban, during or before procedures. The guideline did not review evidence for people with heart problems other than atrial fibrillation.

May was National Stroke Awareness Month and to learn more about stroke, visit the American Academy of Neurology website.(3)

References 1. Armstrong MJ, Gronseth G, Anderson DC, Biller J, Cucchiara B, Dafer R, Goldstein LB, Schneck M, and Messé SR. Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, May 28, 2013 80:2065-2069. 2. Guideline author Melissa J. Armstrong, MD, an assistant professor of neurology with the University of Maryland School of Medicine in Baltimore. 3.

Maria Perno Goldie, RDH, MS

To read previous RDH eVillage FOCUS articles by Maria Perno Goldie, click here.

To read more about strokes and dental hygiene, click here.