Suggestions For Anticoagulation Management Before And After Dental Procedures

Management of anticoagulation before and after dental procedures requires careful, patient-specific evaluation of the risk of bleeding associated with the dental procedure as well as the risk of thromboembolism associated with the underlying disease state for which anticoagulation is indicated. Patient specific management plans will be made in consultation with the dentist performing the procedure.

	Low bleeding risk	Moderate bleeding risk	High bleeding risk
Procedures	Supragingival scaling Simple restorations Local anesthetic injections	Subgingival scaling Restorations with subgingival preparations Standard root canal therapy Simple extractions Regional injections of local anesthetics	Extensive surgery Apicoectomy (root removal) Alevolar surgery (bone removal) Multiple extractions
Suggestions	Do not interrupt anticoagulant  therapy Use local measures to control bleeding	Interruption of anticoagulant therapy in not necessary Use local measures to prevent or control bleeding Consult w/ dentist to determine comfort with use of local measures to prevent bleeding when anticoagulation is not interrupted	May need to interrupt anticoagulant therapy For patients on warfarin,  Follow “Suggestions for warfarin management before and after invasive procedures” For patients taking direct oral anticoagulants (DOACs), follow drug-specific recommentations for peri-procedural management Use local methods to prevent or control bleeding