On Aspirin or Warfarin for Stroke Prevention, Need Dental Work or Minor Surgical Procedure, What to do?

We have previously blogged about the importance of antiplatelet and anticoagulant drugs for stroke prevention.

Let’s say you are taking one of these drugs, and you need to have dental work, or a minor surgical procedure.  Is it safe to hold the drug?  What should you do?

Obviously you are weighing the risk of a recurrent stroke against the risk of complications from increased bleeding during the procedure.

A recent evidence based guideline from the American Academy of Neurology tries to address some of these concerns.

Here is what it says:

If you are taking aspirin, it’s probably OK to continue it while you undergo dental work, skin biopsy, cataract surgery, epidural injections, EMG, endoscopy, colonoscopy and prostate biopsies.

If you are taking warfarin, it’s probably OK to continue it while you undergo dental work, skin biopsy and EMG.

Otherwise, you might need to temporarily hold the aspirin or warfarin for the procedure.

Unfortunately, that is where the guidelines end – There is insufficient data to make formal recommendations about how long these medications should be held for, when they should be re-started, and if patients should be a on “bridging drug” (like Lovenox or heparin shots) while warfarin is held.   These are still decisions that have to made on a case by case basis after careful discussion with your doctor(s).


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