DENTAL CARE

Q:

How Many Days Before My Visit Should I Stop Taking My Blood Thinner? (Part 2)

A:

Last week we started to deal with this frequent question. We discussed the general types or categories of blood thinners. Different patients take these medications for various reasons. The indications for all blood thinners is a consistent one. There is a concern for developing a blood clot. Blood clots that travel throughout the body can cause restricted or blocked blood flow to an area of the body. Since blood is vital to the health of our entire body, a decrease is not good. If one of these clots should affect the brain or heart, the result could be a stroke or heart attack resulting in death. We ended last week with categorizing or grouping of dental procedures into two broad categories. One category involves a risk of gum irritation resulting in bleeding. The second category is that which does not include gum irritation. The latter category does not require stopping the blood thinner at all. What do we do if gum irritation and potential bleeding will occur? Many patients are taking some newer drugs. We mentioned last week that some of these are Pradaxa, Eliquis, and Xarelto. These drugs stay in the body for a shorter period than older types of blood thinners that were used to prevent clot formation. If a decision is made to stop these drugs, the time for this does not need to be very long. I had a brief conversation this week with a Dr. Robert Goldstein, Director of Cardiac Electrophysiology at Lake Health. He pointed out that a day or two, at the most, is needed for the newer drug if we decide to interrupt these newer medications. According to the American Dental Association, procedures that had bleeding potential and classified as low or medium risk were evaluated retrospectively. These procedures included gum cleaning and extractions of 2-4 teeth and limited gum surgery. They observed that bleeding was generally mild whether the drug was interrupted or not. Techniques to control the bleeding were easy to use, and no issues observed. It seems that the consensus in medicine today is that there is no real reason to stop these medications for an overwhelming number of dental procedures. If this is the case, why do we stop them? One reason could be a fear of severe bleeding, but as we have presented, this is not valid. The other reason is one of convenience. If a patient can stop blood thinners, then my procedure will go faster. I don’t have to spend time dealing with bleeding. If I don’t have to deal with bleeding issues, then my patients will get in and out of the chair faster. I have found that this is always a plus. The benefit in medicine of less time resulting in less procedural post-op issues is real. The other benefit is a psychological one for the patient. They feel happy to have a quick procedure As always never change any medicine on your own. I ask my patients to get clear direction from their physician. I can not stress the importance of talking to your physician and create a conversation with your dentist. Fear of bleeding is real, but the creation of a blood clot is also real. I look forward to hearing from you. Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.