Millions of adults in the US take anticoagulant medications daily, also known as blood thinners. Aspirin is the most well-known, but there are several other prescription blood thinners a person may use to prevent blood clots, which can be life-threatening. Much of the population that’s on anticoagulants are older adults who have a history of stroke, heart problems and/or blood vessel disorders in order to prevent future, possibly fatal, medical complications.
Blood thinners on their own are a delicate balance of how-thin-is-too-thin? – you want to prevent dangerous clots, but not thin your blood so much you bleed out at an otherwise minor injury. When you add oral surgery and anesthesia to the mix, it gets even more complicated. Any invasive procedure brings with it the chances of clotting and bleeding. And this is compounded with anesthesia, which also comes with an increased risk of clotting, especially if the patient has deep-vein thrombosis.
This is a lot to manage. It requires a patient-focused, holistic oral surgeon who understands anesthesia, the needs of patients on vital medications, and how blood thinners interact with sedation for oral procedures. Patients need to be kept informed to feel calm about going in for their surgery.
Safely Navigating Blood Thinners & Surgery
Every week, we see and treat patients taking blood thinning medications. The number of patients we see over the age of 60 taking these medications has significantly increased compared to 5-10 years ago. Many of the patients have been taking these medications for over three years, with no plan of stopping the medication.
People rely on these medications to protect them from severe harm and even death, so the primary question these patients ask us is, ‘Do I need to stop my medication before you can remove my tooth or place an implant?’ It can be terrifying to consider stopping a blood thinner if you have a history of heart complications.
Our reply is, ‘We need to contact your medical doctor managing the medication and have this physician determine the course of action.’ Routinely, we do not want to stop these medications for most procedures; however, the final decision is up to the treating physician. We fax a form to the physician, which, when signed and returned, will determine our plan.
Blood Thinners & Anesthesia for Oral Surgery
Most of the patients we see are on blood thinners other than Coumadin (Warfarin). From a surgical point of view, this complicates the plan at times. Coumadin is the only blood thinner which can be monitored with a blood test – an INR. All of the other medications do not have a test to check the thickness or thinness of the blood.
Also, with any of the blood thinners, we receive a range of time to stop a medication before we can perform our procedure. Sometimes the physician states for a 2-day hold, and other times we obtain an order to hold the same medication for 7 days. Dr. Puckett works closely with your physician to ensure that before, during and after your mouth surgery, your heart is happy and your health is safe.
Safe Dental Surgeries Require Cooperative Care
We never tell the patient to stop their blood thinner medication without coordinating the plan with the medical doctor. Occasionally, patients self-stop the blood thinner in hopes of having the tooth addressed without involving the physician. However, we will not remove the tooth without contacting the physician first.
Patient safety is of paramount importance; therefore, we will make every effort to address medically complex patients thoroughly and with minimal delay. Minor bleeding while continuing the blood thinner is a nuisance, but a heart attack or stroke from being off of the blood thinner too long is life changing.
