- Antiplatelet medications and anticoagulants work to prevent clots in blood vessels.
- Antiplatelets medication interfere with platelet aggregations, which is the start for blood clot formation.
- Anticoagulants interfere with different factors the coagulation process. The coagulation process attempts to stabilize a blood clot.
- PT and INR should be measured within 24 hours to be considered valid.
- Anticoagulation level is measured by prothrombin time (PT) and international normalized ratio (INR).
- PT – Normal range is 11-13 seconds; goal for anticoagulation is 16-20 seconds.
- INR – normal range is 1.0-1.3; goal for anticoagulation is 2.5-4.5.
- Only a physician should make changes to a patient’s anticoagulation therapy.
- If coumadin (Warfarin), a vitamin K antagonist, is discontinued, the effect will take place only 2 days later. If no alternative anticoagulation therapy is instituted during this time, there is an increased risk for the patient to develop a thromboembolic event.
- Alternative anticoagulation therapy includes fractionated and unfractionated (low molecular weight heparin [LMWH]) heparin.
- Apixaban (Eliquis), a novel direct factor Xa inhibitor, has been shown to be beneficial in patients with atrial fibrillation to prevent the incidence of strokes.
- Other new alternatives to warfarin therapy are rivaroxaban (Xarelto), another factor Xa inhibitor, and dabigatran (Pradaxa), a direct thrombin inhibitor.
- DO NOT discontinue warfarin therapy within the first 6 months after bioprosthetic aortic valve replacement.
- No need to discontinue aspirin, or aspirin in combination with other antiplatelet medications, used to prevent thromboembolic events, for routine dental procedures or simple extractions.
- DO NOT discontinue dual antiplatelet therapy in patients within the first year after the placement of coronary artery stents.
|Drug Category||Generic name||Trade name|
(glycoprotein IIb/IIIa inhibitors)
(coumarins ans indandiones)
(factor Xa inhibitors)
(Tables adapted from Sousa-Uva M, et al.)
|Half-life||1-2 hours||2-15 hours||7-9 hourd||3-6 minutes|
|Frequency of administration||Once daily||Once daily||Twice daily||IV infusion|
|Duration of effect||3-10 days||7-10 days||3-5 days||1-2 hours|
before non-acute surgery
|At least 5 days||At least 7 days||At least 3 days||1 hour|
|Vitamin K Antagonists||Acenocoumarol |
(not approved by
|Half-life||10 hours||35-80 hours||30-40 hours||3-4 days|
|Steady state||2-3 days||3-4 days||3-4 days||6 days|
|Duration of effect||2-4 days||4-5 days||2-3 days||4-5 days|
|Non-Vitamin K Antagonist|
Oral Anticoagulants (NOACs)
|Target||Factor Xa||Thrombin||Factor Xa||Factor Xa|
|Tmax||3 hours||2 hours||1-3 hours||2-4 hours|
|Half-life||9-14 hours||14-17 hours||5-11 hours||9-13 hours|
|Renal excretion||25%||80%||36-45%||66% (half inactive)|
|Antidote||Andexanet alfa |
|Idarucizumab|| Andexanet alfa |
| Andexanet alfa |
before non-acute surgery
|At least 48 hours||At least 48 -96 hours||At least 48 hours||At least 48 hours|
| Drugs/ drug|
See Medical Complexity Status for more information.
- Medical Disorders
- Oral Health Care Considerations
- Laboratory Values
- Aframian DJ, et al. Management of dental patients taking common hemostasis-altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(suppl 1):S45.e1-S45.e11.
- Baron TH, et al. Management of antithrombotic therapy in patients undergoing invasive procedures. N Engl J Med 2013;368(22):2113-24.
- Engelen ET, at al. Antifibrinolytic therapy for preventing oral bleeding in people on anticoagulants undergoing minor oral surgery or dental extractions. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD012293
- Grines CL, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents. J Am Dent Assoc. 2007;138(5):652-5.
- Halpern LR, et al. Treatment of the Dental Patient with Bleeding Dyscrasias: Etiologies and Management Options for Surgical Success in Practice. Dent Clin North Am. 2020;64(2):411-434.
- Kaplovitch E, et al. Treatment in the dental practice of the patient receiving anticoagulation therapy. J Am Dent Assoc. 2019;150(7):602-608.
- Kumbhani DJ, et al. 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease. JACC. 2021;77(5):629-658.
- Mahmood H, et al. Antiplatelet drugs: a review of pharmacology and the perioperative management of patients in oral and maxillofacial surgery. Ann R Coll Surg Engl. 2020 Jan;102(1):9-13.
- Romney G, Glick M. An Updated concept of coagulation with clinical implications. J Am Dent Assoc. 2009;140(5):567-74.
- Sousa-Uva M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. European Journal of Cardio-Thoracic Surgery. 2018; 53(1):5–33.
- Weltman NJ, et al. Management of dental extractions in patients taking warfarin as anticoagulant treatment: a systematic review. J Can Dent Assoc. 2015;81:f20.