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Anticoagulation/Antiplatelet Medications and Considerations


  • 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.

Anticoagulation therapy guidelines#

Routine dental care, including simple extractions, can be performed with a PT <20 seconds or an INR <3.5.#

  • 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.

Antiplatelet therapy guidelines#

  • 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.

Anticoagulation and antiplatelet medications#

Drug CategoryGeneric nameTrade name
Antiplatelet agents
  • Aspirin
  • Aspirin and dipyridamole
  • Cilostazol
  • Dipyridamole
  • Aspirin
  • Aggrenox
  • Pletal
  • Persantine
Intravenous antiplatelet
(glycoprotein IIb/IIIa inhibitors)
  • Abciximab
  • Eptifibatide
  • Tirofiban
  • ReoPro
  • Integrilin
  • Aggrastat
Oral antiplatelet
(P2Y12 Inhibitor)
  • Cangrelor
  • Clopidogrel
  • Prasugrel
  • Ticagrelor
  • Ticlopidine
  • Kangreal
  • Plavix
  • Effient
  • Brilinta
  • Ticlid
(coumarins ans indandiones)
  • Warfarin
  • Coumadin, Jantoven
(factor Xa inhibitors)
  • Apixaban
  • Betrixaban
  • Endoxaban
  • Fondaparinux
  • Rivaroxaban‡
  • Eilquis
  • Bevyxxa
  • Savaysa
  • Arixtra
  • Xarelto
  • Dalteparin
  • Danaparoid
  • Endoxaparin
  • Tinzaparin
  • Fragmin
  • Orgaran
  • Lovenox
  • Innohep
(thrombin inhibitors)
  • Bivalirudin
  • Dabigatran
  • Desirudin
  • Lepirudin
  • Angiomax
  • Pradaxa
  • Lixiana
  • Refludan

Considerations for invasive dental procedures#

(Tables adapted from Sousa-Uva M, et al.)

P2Y12 InhibitorsClopidogrelPrasugelTicagrelorCangrelor
Half-life1-2 hours2-15 hours7-9 hourd3-6 minutes
Frequency of administrationOnce dailyOnce dailyTwice dailyIV infusion
Duration of effect3-10 days7-10 days3-5 days1-2 hours
Antidote NoNoNoNo
before non-acute surgery
At least 5 daysAt least 7 days At least 3 days 1 hour
Vitamin K AntagonistsAcenocoumarol
(not approved by
Half-life 10 hours35-80 hours30-40 hours3-4 days
Steady state2-3 days3-4 days3-4 days6 days
Duration of effect2-4 days4-5 days2-3 days4-5 days
Non-Vitamin K Antagonist
Oral Anticoagulants (NOACs)
Target Factor XaThrombinFactor XaFactor Xa
Tmax3 hours2 hours1-3 hours2-4 hours
Half-life9-14 hours14-17 hours 5-11 hours 9-13 hours
Renal excretion25%80% 36-45%66% (half inactive)
AntidoteAndexanet 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

Medical Complexity Status - Anticoagulation/Antiplatelet Therapy#

antiplatelet therapy
 Drugs/ drug

See Medical Complexity Status for more information.

Related Pages#