If you’ve spent enough time in an outpatient dental clinic, you’ve probably come across this scenario quite often. In my OPD, 3–5 out of every 30 patients are on aspirin therapy.
And almost every time, the same question arises:
“Should we ask the patient to stop aspirin before extraction?”
For years, the answer seemed simple. Since aspirin irreversibly inhibits platelet aggregation and its effect lasts for the lifespan of the platelet (about 7–10 days), patients were advised to discontinue it a week before extraction, usually after consulting their physician.
But with evolving evidence, is it still the best approach?
Current dental literature suggests that for most patients undergoing simple tooth extractions, continuing aspirin monotherapy is generally safe. Yes, bleeding may be slightly prolonged, but in the most of the cases it can be effectively controlled with simple local haemostatic measures such as pressure, suturing, or other haemostatic agents when required.
The bigger concern, is why the patient is under aspirin therapy?
For many patients, aspirin isn’t just another medication—it’s prescribed to reduce the risk of serious cardiovascular events. Interrupting that therapy may increase the risk of myocardial infarction, stroke, or other thromboembolic complications, which can have far more serious consequences than the manageable bleeding associated with a routine extraction.
Interestingly, one review reported that 92% of bleeding episodes were controlled within 10 minutes using pressure alone, while the remaining cases were successfully managed with local haemostatic measures.
So, what does this mean in practice?
Rather than routinely asking every patient to stop aspirin, current evidence encourages us to individualize our approach.
Take a thorough medical history. Understand why the patient is taking aspirin. Consider the complexity of the extraction. Communicate with the patient’s physician whenever needed. And most importantly, be prepared to manage bleeding with appropriate local measures.
Evidence-based dentistry isn’t about eliminating every possible risk—it’s about balancing risks and making decisions that are safe for the patient as a whole.
What are your thoughts on this? Have you changed your approach to patients on aspirin therapy over the years, or do you still prefer discontinuation before extractions in certain situations? I’d love to hear your perspective.
MBH/PS
Modern guidelines strongly emphasize that the systemic cardiovascular risks of stopping aspirin far outweigh the localized bleeding risks of a simple extraction. Local hemostatic tools make chairside bleeding highly manageable!