Patients on anticoagulants
Warfarin and DOACs — usually do not stop for routine extractions.
- Warfarin: check INR within 24 h (72 h if stable). Proceed if INR < 4 with local haemostatic measures.
- DOACs (apixaban, rivaroxaban, dabigatran, edoxaban): for higher-risk procedures, schedule early in the day; consider missing/delaying the morning dose per protocol (SDCEP).
- Local measures: oxidised cellulose/collagen in socket, sutures, pressure, tranexamic acid 5% mouthwash.
- Antiplatelets (aspirin, clopidogrel): do not stop.
UK vs US
UK / Europe
SDCEP 2022: higher-risk procedures — apixaban/dabigatran: miss the morning dose; rivaroxaban/edoxaban: delay the morning dose until 4 h after haemostasis.
United States
ADA: generally do not interrupt anticoagulants for dental procedures; consult the prescribing physician for complex surgery.
Sources
- SDCEP — Management of dental patients taking anticoagulants or antiplatelet drugs (2022)UK
- ADA — Oral health topics libraryUS
Checked against these sources on 2026-10-22. Guidelines change — open the source to confirm.
Summarised from the sources above. Always verify against current local guidelines and the patient's medical history.
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