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Blood thinners are prescription medications that are taken by most dental patients. Blood thinners are used in medicine to prevent potentially fatal blood clots, which can lead to stroke, heart attack, deep vein thrombosis (DVT), or pulmonary embolism (PE). These blood thinners prevent clotting, but they cause a potential danger to dental procedures that may cause bleeding. However, the lifesaving benefits of these drugs very often outweigh the potential dangers.
How Does Blood Clotting Work?
There are two main processes by which the body forms a blood clot on its own. The first process uses platelets (small blood cells) which go to the site of a wound and clump together to form a plug. This slows the flow of blood through the vessel and forms a covering to begin the healing process. The second phase of the process is called coagulation, when proteins in the blood bind with each other to fill in the gaps between the platelets, stabilize the clot formation, and to make it more solid until the bleeding stops.
Blood Thinner Medications
There are 2 types of blood thinners. They include the following:
Antiplatelet – These blood thinners include aspirin, Ticlid (ticlopidine), and Plavix (clopidogrel). They target the initial phase of the clot process by preventing platelets from binding to the blood vessel walls or to each other. Aspirin is a good example of how these medicines act on the body. Aspirin achieves this is by making permanent changes in the platelets, which last throughout the lifetime of the platelet (approximately 7-10 days). This can only be reversed once the body produces new platelets that have not yet been exposed to Aspirin.
Anticoagulant – These blood thinners include Coumadin (warfarin). Coumadin works by inhibiting the second phase of blood clotting, by blocking production or the function of proteins that stabilize the clot (also called anticoagulation). Coumadin takes several days after the start of the medication to reach its full anticoagulation effect, and then several days after the medication is stopped for the anticoagulation effect to stop. Certain foods and other medications can affect coumadin by either increasing or decreasing its effectiveness. Your physician will need to frequently check your level of anticoagulation activity.
Newer anticoagulants have entered the market and these include, Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (apixaban). These medications have an advantage over coumadin, they do not take as long to reach their full anticoagulation effect. Also, to stop that effect when discontinued. The downside is their anticoagulation activity cannot be monitored as easily by doctors as it is for coumadin. Another medication, Lovenox (enoxaparin), is used to prevent a pulmonary embolism (PE) and Deep vein Thrombosis (DVT). These blood thinners are given through self-injection.
Dentist Preparations For Blood Thinners
Typically, bleeding from dental procedures is fairly easy to control, even in patients who are taking blood thinner medications. It is important to note that both the effect of these medicines on blood clotting and the potential for bleeding from dental procedures can vary from individual to individual. So, each patient must be carefully considered based on their clotting factor before the dental procedure. A consultation with the patient and their physician can lead to a change in dose prior to the dental procedure, or even stopping the medication altogether to complete the dental work.
It is very important for individuals on blood thinner medications to speak with their dentist about their medical history. Your dentist will ask you to provide a complete medical history including:
- All medical conditions (including heart disease, irregular heartbeat, stroke, liver disease, kidney disease, and/or history of blood clots).
- All medications currently being taken. Not just blood thinners, but all medications. This is important because they could interact with what your dentist is using.
- Treating physician information.
- Reason for taking blood thinners.
- Anticipated time that you will be on blood thinners.
- The results of your monitoring of the effects of these agents (blood test results).
- Any issues that have arisen from your blood thinners.
Your dentist may ask to run some tests prior to your dental treatment and call your physician before attempting to do the dental procedure(s). Your dentist may also ask to do the dental procedure in one of three ways:
- To continue taking blood thinners as normal with no changes.
- Alter the dose or type of blood thinners for a short period of time.
- Stop the blood thinners altogether prior to the dental procedure.
Precautions may be taken by your dentist before, during, and after the dental procedure, to reduce the chances of significant oral bleeding. It is important to never discontinue or change your blood thinners or dose without the advice of your physician and dentist. It is also important to be aware that over-the-counter medications such as Motrin, Advil and Aleve, can also increase the anti-platelet effects. Additionally, “non-traditional” medications can interfere with or increase the effects of your anticoagulant medications.
Dental Procedures With Bleeding Risks
The following are the procedures most linked to increased bleeding:
- Professional teeth cleaning (also referred to as dental prophylaxis)
- Scaling and root planning (also referred to as a deep teeth cleaning)
– Periodontal surgery
- Tooth extractions
– Dental implant placement
Taking blood thinners has many benefits, but also some risks. We can minimize these risks, at least on the dental side, by communicating properly to have your dental procedures completed safely and successfully. Remember, to maintain a dental hygiene routine and dental examination schedule for a healthy smile.