Most patients taking anticoagulant or antiplatelet medication can receive routine dental treatment without stopping therapy. Management depends on the drug, procedure-related bleeding risk, renal function, INR where relevant, comorbidities and local haemostasis; medication changes require prescriber coordination.
Contents
Pre-treatment assessment
- Identify the medication, dose, indication, timing and prescriber.
- Assess procedure-related bleeding risk and whether treatment can be staged.
- Review renal or hepatic impairment, previous bleeding and interacting medicines.
- For warfarin, obtain an appropriately timed INR under current guidance.
- Plan care when postoperative support is available.
Warfarin, DOACs and antiplatelets
Warfarin management is guided by INR and procedure risk. Direct oral anticoagulants require attention to dose timing, renal function and whether treatment has low or higher bleeding risk. Antiplatelet therapy is usually continued for routine dental procedures because interruption can expose the patient to serious thrombotic harm.
Dental planning table
| Group | Key assessment | General principle |
|---|---|---|
| Warfarin | Current INR and interactions | Treat within guidance thresholds with local haemostasis |
| DOAC | Dose timing, renal function, bleeding risk | Low-risk procedures often proceed; higher-risk care may require timing adjustment |
| Single antiplatelet | Drug and indication | Usually continue |
| Dual therapy | Indication and procedure risk | Do not stop without specialist advice |
Local haemostasis
- Use atraumatic technique and limit the initial treatment area.
- Place a haemostatic material when indicated.
- Suture to stabilise the clot.
- Confirm haemostasis before discharge.
- Provide written instructions and emergency contact information.
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