Post-op Instructions for Patients on
Medications affecting Blood Clotting
Pre-Operative Management

Patients taking low-dose Aspirin (75mg - 300mg daily),
Clopidogrel (Plavix), Dipyridamole (Persantin, Persantin
, Asasantin Retard) or are taking Warfarin are at
greater risk of bleeding after teeth have been removed or
after a biopsy has been performed.

Patients taking low-dose
Aspirin, Clopidogrel, Dipyridamole
or are taking
Warfarin should not have their medications
stopped or altered prior to dental surgical procedures
unless advised otherwise.

If the patient is on
Warfarin, the INR is checked on the day
of extraction or biopsy.  If the INR is below 3.5 – 4.0, then
the extraction / biopsy can be done.

Peri-Operative Management

To minimise bleeding after the extraction / biopsy:

  • the socket can be stuffed with various materials that
    assist clotting
  • the socket is stitched up tightly &
  • a mouth rinse containing Tranexamic Acid (this
    prevents the breakdown of blood clots) can be

Post-Operative Management

Patients should:

  • look after the initial clot at the operation site by resting
    while the local anæsthetic wears off & the clot fully
    forms (2 - 3 hours)
  • avoid rinsing the mouth for 24 hours
  • not to suck hard or disturb the operation site with the
    tongue or any foreign object
  • avoid hot liquids and hard foods for the rest of the day
  • avoid chewing on the affected side until it is clear that a
    stable clot has formed.  Care should then be taken to
    avoid dislodging the clot
  • bleeding continue or restarts, to apply pressure over
    the socket using a folded clean handkerchief or gauze
    pad.  Place the pad over the socket and bite down
    firmly for 15 - 20 minutes.  If bleeding does not stop,
    the Oral Surgeon should be contacted; repacking and
    re-stitching of the socket may be required

How Should Post-Operative Pain Be Managed?

Patients should follow the advice of their Anticoagulant
with regard to the choice of painkillers for short-term
mild to moderate pain.

Paracetamol is considered the safest simple
painkiller for patients taking
Warfarin and it may be taken in
normal doses if pain control is needed and no contra-
indication exists.

Patients should not to take
Aspirin, Aspirin-containing
compound preparations or Non-Steroidal Anti-Inflammatory
Drugs e.g.
Ibuprofen, which are considered less safe than
Paracetamol in patients taking Warfarin.

Patients requiring a course of antibiotics post-operatively
should be vigilant for any signs of increased bleeding.
Last Updated 23rd June 2010