Aspirin Therapy - Stop or Not Before Surgery

This past Monday morning began like most Monday mornings. A patient insisted upon speaking to me. “It’s an emergency” he said when I picked up the phone. “Doc, you’ve got to help me.” “I’ve been in pain all weekend.” “I had a little “stroke” a few years ago and take aspirin every day.” “I need my tooth extracted; but I can’t wait a week until the aspirin is out of my body, I’m in too much pain”. I told him that patients in pain are always seen that same day. Later that afternoon he was seen and treated, the tooth was extracted, and he was free of pain without any complications. The patient was taking a “baby” aspirin daily because of his past medical history and his dentist had told him to stop taking the aspirin a week before he had the tooth extracted because of concerns of excessive bleeding. The patient was equally concerned that he might have another “stroke” if he stopped the aspirin therapy.

Many patients are taking low dose aspirin (75-100mg) as part of their therapy for angina, ischemic heart disease, post-myocardial infarction, post- bypass surgery, stroke, or transient ischemic attacks (T.I.A.). Usually the intake of aspirin is halted before surgical procedures, including oral surgery to avoid the development of uncontrollable bleeding. Sometimes this is impractical or the suspension of therapy heightens the risk of for the patient to suffer a thromboembolism, myocardial infarction, or cardiovascular accident.

A study reviewed in the Journal of Oral and Maxillofacial Surgery evaluated 51 men and women taking low dose aspirin for 1-15 years. All underwent oral surgery under local anesthesia. All of the patients did well with no episodes of bleeding. This result is similar to recent studies of patients who are taking the anti-coagulant medications Coumadin or Plavix and who cannot have their medications stopped because they are at high risk of “stroking out” or having a myocardial infarction.

SUMMATION: Most minor oral surgical procedures can be easily and safely performed while the patients continue their low dose aspirin therapy. The very low risk of post-surgical bleeding is of a significantly lesser concern than the more significant problems of patients developing a thrombolembolis or a myocardial infarction.

‍Gerald S. Fine, D.D.S.

Practice limited to oral & maxillofacial surgery‍