Are blood thinners OK prior to oral surgery?

Stroke patients do not need to discontinue taking blood thinners such as aspirin and warfarin prior to undergoing dental procedures, according to a new guideline from the American Academy of Neurology (Neurology, May 28, 2013).

But they should discuss it with their physician or dentist prior to even minor surgery, the guideline authors emphasized.

The risk of bleeding varies depending on the procedure, according to the guideline, which was developed by reviewing all available evidence to date. For many minor procedures, including dental procedures, the bleeding risk from continuing blood thinners is fairly small.

"This guideline helps patients and doctors know what the evidence tells us about these different risks," said guideline author Melissa J. Armstrong, MD, an assistant professor of neurology with the University of Maryland School of Medicine in Baltimore, in a press release. "A person's health history and preferred course of action are also important to discuss when making this decision."

Most of the studies on bleeding risks from blood thinners during procedures focus on aspirin and warfarin. More research is 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, Dr. Armstrong noted.