For most routine extractions, no. Current guidance is to continue anticoagulant and antiplatelet therapy and control bleeding locally instead, because the risk of a clot or stroke from stopping outweighs the bleeding risk from continuing.
That’s a reversal of what patients were told for decades, and plenty of advice online still reflects the old approach. Here’s what the evidence actually supports, by drug.
Never stop a blood thinner on your own. Not for a day, not “just to be safe.” That decision belongs to the physician who prescribed it, in conversation with your oral surgeon.
Why the advice changed
The old logic was intuitive: thinner blood, more bleeding, so pause the drug. What that reasoning left out was what happens during the pause.
Anticoagulants are prescribed to prevent strokes, pulmonary embolism and clots on mechanical heart valves. Interrupting them opens a window where those events can occur — and unlike post-extraction bleeding, a stroke isn’t fixable with gauze and pressure.
Historically, interrupting antithrombotic therapy was advised, but contemporary guidance discourages it because of the thromboembolism risk, and supports proceeding with most minor oral surgical procedures without interruption, provided solid local measures to control bleeding are used.
The bleeding side turned out to be less dramatic than feared. A meta-analysis of roughly 600 patients found no significant difference in post-operative bleeding whether anticoagulation was continued or interrupted.
Warfarin (Coumadin)
Usually continued. Clinical guidelines predominantly support continuing warfarin without interruption for dental surgery, and extractions performed at a therapeutic INR of 2.0 to 4.0 seldom cause severe bleeding in the immediate post-operative period.
Your INR needs checking first. The practical rule is a recent INR — within 24 hours of the procedure, or within 72 hours if your readings have been stable — and a value at or below 3.5 for extractions in a primary care setting. An INR nearer 2.7 gives extra margin where haemostatic support is limited.
If your INR is above the threshold, the extraction is usually deferred rather than the warfarin stopped, and your anticoagulation clinic is contacted.
What to bring to your appointment: your most recent INR result and the date, your usual dose, and your anticoagulation clinic’s details.
DOACs — Eliquis, Xarelto, Pradaxa, Savaysa
These are apixaban, rivaroxaban, dabigatran and edoxaban. No INR monitoring is needed, and they’re now the usual choice for most patients with non-valvular atrial fibrillation, while warfarin remains indicated for mechanical heart valves or severe mitral stenosis.
Usually continued, with timing adjusted rather than doses skipped. The approach is to schedule the procedure at the drug’s trough concentration — roughly 24 hours after the last dose for once-daily agents like rivaroxaban and edoxaban, and roughly 12 hours for twice-daily agents like apixaban and dabigatran. Omitting a dose is usually unnecessary for routine cases.
In practice this often means a late-morning or afternoon appointment rather than first thing, with you taking your dose after the procedure rather than before.
What the data shows. A 2024 study of 246 patients who continued DOAC therapy through extraction found post-extraction bleeding complications in 4.9%, with no significant difference compared to those who stopped. A 2025 prospective cohort concluded that patients may safely continue DOACs during and after both simple and surgical extractions, and that uninterrupted DOAC patients may have a lower bleeding risk than those on warfarin.
Where bleeding does occur, it’s generally mild and manageable with local measures.
Kidney function matters. DOACs are cleared renally, and severe impairment changes the plan. Bring recent bloodwork if you have kidney disease.
Aspirin, clopidogrel and dual antiplatelet therapy
Aspirin, Plavix (clopidogrel), Brilinta and Effient work differently from anticoagulants — they stop platelets sticking rather than interfering with clotting factors.
Generally continued. This applies to low-dose aspirin and to clopidogrel, and usually to dual antiplatelet therapy as well. For anyone with a coronary stent, stopping is particularly hazardous — stent thrombosis is a serious event, and the window matters most in the months after placement. If you have a stent, say so and say when it was placed.
What we do instead of stopping your medication
The entire modern approach rests on controlling bleeding at the site rather than systemically. That means:
- Atraumatic technique — less tissue damage, less bleeding
- Sutures to close and stabilise the socket
- Oxidised cellulose or collagen plugs placed into the socket
- Tranexamic acid mouthwash, which inhibits clot breakdown, used after the procedure
- Sustained gauze pressure, longer than standard
- Platelet rich fibrin, drawn from your own blood, which supports clot stability at the site
- Scheduling early in the day and early in the week, so if bleeding restarts you’re reaching someone easily
These measures are the condition on which continuing therapy is considered safe. They’re why “continue the blood thinner” is sound advice in a planned setting and less so in an improvised one.
Routine versus higher-risk procedures
| Procedure | Typical approach |
|---|---|
| Single simple extraction | Continue therapy, local measures |
| Two or three extractions, one quadrant | Continue therapy, local measures |
| Surgical extraction, impacted wisdom tooth | Usually continue; planned carefully |
| Multiple extractions across the mouth | May be staged across visits instead of stopping medication |
| Full arch surgery, extensive implant work with grafting | Case-by-case, in consultation with your physician |
| Severe kidney impairment, liver disease, or a bleeding disorder on top of anticoagulation | Specialist input; sometimes hospital setting |
Staging treatment — doing a little at a time — is often the better lever than pausing medication.
Expect some bleeding, and know what to do
Secondary bleeding at 24 to 48 hours is anticipated in anticoagulated patients and is managed with repeat local measures.
If bleeding restarts at home:
- Sit upright, head above heart. Don’t lie down.
- Roll clean gauze into a firm pad, place it directly over the socket, and bite hard for 30 minutes without checking.
- If still bleeding, repeat with fresh gauze for another 30 minutes. A damp black tea bag works in place of gauze.
- No rinsing, spitting, straws, smoking, alcohol or hot drinks.
- Use the tranexamic acid mouthwash if you were given it, exactly as instructed.
Call the office if bleeding continues after two rounds of firm pressure, if you’re swallowing blood steadily, or if you feel lightheaded. Go to an emergency department for bleeding you can’t slow at all, or if you feel faint or short of breath.
Our guide to what’s normal in the first 48 hours after an extraction covers the baseline — bear in mind your own threshold for calling should be lower.
One thing to raise about painkillers
NSAIDs — ibuprofen, naproxen — affect platelet function and irritate the stomach lining, and combining them with anticoagulants raises bleeding risk, particularly gastrointestinal bleeding.
This matters because NSAIDs are otherwise the first-line choice after extractions. If you’re anticoagulated, ask specifically what you should take for pain rather than defaulting to the ibuprofen in your cupboard. Acetaminophen is often preferred, though it has its own interaction with warfarin at sustained doses, so this is a conversation rather than a rule.
What your oral surgeon needs to know
- Every anticoagulant and antiplatelet you take, with doses
- Why you take it — atrial fibrillation, DVT, a mechanical valve, a stent, previous stroke
- When your last dose was, and your usual timing
- Your most recent INR and date, if on warfarin
- Recent kidney and liver function results, if you have either condition
- Your prescribing physician or anticoagulation clinic’s contact details
- Any history of unusual bleeding, with past procedures or otherwise
- Supplements too — fish oil, high-dose vitamin E, ginkgo, garlic and turmeric all have mild effects
Supplements get left off medication lists constantly. Mention them.
Common questions
My dentist told me to stop Eliquis for three days. Is that wrong?
It’s at odds with current guidance for routine extractions, but there may be a specific reason — a complex surgical case, kidney impairment, something in your history. Ask what the reason is, and make sure your prescribing physician agrees. Don’t act on an instruction from one clinician that contradicts another without the two of them speaking.
What if I already stopped it?
Tell both your surgeon and your prescriber today. Don’t double up to catch up.
Can I have dental implants on blood thinners?
Generally yes. The same principles apply, with planning scaled to the complexity of the case — implant surgery involving grafting or multiple sites gets more deliberate attention than a single socket.
Is sedation affected?
Sedation itself isn’t, but the overall medical picture that comes with anticoagulation — heart disease, previous stroke, kidney function — does inform the anesthesia plan.
I’m on warfarin and need an emergency extraction for an infection. Can it wait for an INR?
Usually a same-day INR is obtainable, and an infected tooth is itself a reason not to delay. Dental infections can escalate quickly — this guide to serious jaw infections covers the warning signs.
Does aspirin count?
It does, and people routinely forget to mention it because it’s over the counter. Low-dose daily aspirin is generally continued, but say that you take it.
