What are blood thinners?

Because heart and vascular diseases are common, many adults visiting a dental clinic take one of these medications. That is why taking a complete medication history before an extraction is the first and most important step in planning.

So-called “blood thinners” do not actually thin the blood; they slow down clotting to prevent clots forming inside blood vessels. They are vital in conditions such as heart rhythm disorders (atrial fibrillation), artificial heart valves, stents, previous stroke, deep vein thrombosis or pulmonary embolism. The main groups are:

Should I stop my medication before a tooth extraction?

Not on your own. Stopping these medications can increase the risk of serious events such as stroke, heart attack or a clot on a heart valve. These risks can have far more severe consequences than bleeding after an extraction. Oral surgery sources also stress that the dentist should never change an anticoagulant dose without close cooperation with the prescribing doctor.

In the past, stopping the medication a few days beforehand was often recommended. Current clinical guidelines, however, recommend that for simple and limited extractions the medication is usually continued and bleeding is controlled with local methods. For more extensive surgery or in patients with additional risk factors, the decision is made together with the cardiologist, neurologist or haematologist.

Why is INR important for people on warfarin?

INR is a standard blood test that shows how much warfarin slows down clotting. The target value depends on why it is used; for example, it is usually 2–3 for rhythm disorders or vein thrombosis, and higher in some patients with mechanical valves.

• An INR measured shortly before the extraction (preferably within 24 hours, and at most 72 hours before in stable patients) is required.
• If the INR is within the target range and below a certain upper limit, simple extractions can usually be done without interrupting the medication.
• If the INR is higher than expected, the procedure is postponed and the doctor managing the medication is consulted.
• For extensive surgery, the target value and any bridging therapy are decided by the prescribing doctor.

Newer blood thinners and aspirin

Drugs such as rivaroxaban, apixaban and dabigatran are not monitored with a routine blood test; their effect starts within a few hours and wears off relatively quickly. For simple extractions the medication is usually continued, and the procedure is scheduled early in the day if possible. In some cases, the prescribing doctor may recommend a timing change, such as delaying the morning dose on the day of the procedure. This decision should only be made jointly by the doctors.

When antiplatelets such as aspirin or clopidogrel are taken alone, they are usually not stopped for simple extractions. Stopping medication is particularly risky for patients with stents on dual antiplatelet therapy; bleeding may be slightly greater, but it can be controlled with local measures.

How is a tooth extraction planned?

1. Detailed medical history: Which medication, at what dose and for which condition?
2. Communication between doctors: If necessary, the prescribing doctor’s opinion is obtained.
3. Timing: If possible, the procedure is scheduled early in the week and early in the day, so any bleeding can be managed the same day.
4. Staged approach: If many teeth need extraction, the procedures may be split into several sessions.
5. Gentle surgery: A technique that reduces tissue trauma is preferred.

How is bleeding controlled?

Even in patients on blood thinners, most bleeding can be stopped with local methods applied in the mouth:

• Placing an absorbable haemostatic material (such as oxidised cellulose or gelatin sponge) in the socket
• Closing the socket with stitches
• Biting firmly and continuously on damp gauze for 20–30 minutes
• Where the dentist considers it appropriate, a mouthwash or local application containing tranexamic acid

At home, for the first 24 hours avoid vigorous rinsing, spitting, drinking through a straw, hot food and drinks, and smoking. For pain relief, use the suitable medication your dentist recommends instead of certain painkillers that can increase bleeding.

What about procedures other than extraction?

Procedures such as scaling, fillings and root canal treatment are usually done without interrupting blood thinners. For more extensive procedures such as gum surgery, multiple extractions, implants and bone grafts, planning is more detailed because the risk of bleeding may increase. The prescribing doctor’s opinion is obtained for these procedures, and if necessary the treatment is split into stages. In people with gum disease, inflamed gums bleed more easily, so completing gum treatment before surgery also makes bleeding easier to control.

When should I seek help immediately?

• Bleeding that does not stop despite 20–30 minutes of firm pressure with gauze
• A dark, “liver-like” clot that keeps growing in the mouth
• Bleeding that starts again a few days after the extraction
• Unexplained bruising on the body, blood in the urine or stool
• Dizziness, palpitations or feeling faint

In such a situation, call our clinic; if you cannot reach us, go to the nearest emergency department and be sure to tell them which medication you take. At Yayla Dental Akademi in Istanbul, extractions for patients on blood thinners are planned with local bleeding control measures after reviewing the medication history, the necessary tests and communication with the relevant doctors.

Frequently asked questions

Related pages

Medically reviewed by: Dr. Dt. Mehmet Fuat BozabaSpecialist in periodontology · September 2026

For appointments and information: Message us on WhatsApp or call 0544 289 66 33. Yayla Dental Akademi, Bahçelievler / Istanbul.

Sources: Fragiskos FD (ed). Oral Surgery. Springer; 2007 · Abubaker AO, Benson KJ (eds). Oral and Maxillofacial Surgery Secrets. 2nd ed. Mosby Elsevier; 2007 · Wayland J. Impacted Third Molars. 1st ed. Wiley-Blackwell; 2018 · Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs. Dental Clinical Guidance; 2015.

This article is for information only; a diagnosis and treatment plan can only be made by a dentist after an examination.