Aspirin Management for Dental Procedures

General Recommendation

Continue low‑dose aspirin (≈75–325 mg daily) uninterrupted for all dental procedures, including single or multiple tooth extractions, because local hemostatic measures are sufficient and the thrombotic risk of stopping aspirin outweighs the minimal bleeding risk. (American Heart Association; American College of Cardiology) [1][2][3][4]

Prospective randomized trials of single‑tooth extractions found no statistically significant difference in postoperative bleeding between patients taking aspirin and those receiving placebo. (American Heart Association) 1
Local hemostatic techniques—absorbable gelatin sponge, suturing, and tranexamic‑acid mouthwash—effectively control any increased bleeding associated with aspirin therapy. (American Heart Association; Canadian Cardiovascular Society) [1][5]
Across multiple studies, there are no well‑documented cases of clinically significant bleeding after dental procedures, even when several teeth are extracted. (American Heart Association; American College of Cardiology) [1][3]

Premature interruption of aspirin markedly raises the risk of coronary‑stent thrombosis, which frequently results in myocardial infarction or death. (American Heart Association; American College of Cardiology) [1][3]
Stopping aspirin also increases the likelihood of other thrombotic events such as stroke or myocardial infarction. (Canadian Cardiovascular Society) 6
The catastrophic potential of these thrombotic complications far exceeds the manageable nature of dental bleeding. (American Heart Association) [1][2]

Dual antiplatelet therapy (aspirin + P2Y12 inhibitor) should be continued for all dental procedures; there is no indication to interrupt either agent. (American Heart Association) [7][8]
If modification of therapy is absolutely necessary, aspirin must be maintained while only the P2Y12 inhibitor may be considered for temporary cessation. (Canadian Cardiovascular Society; Chest Society) [5][9]

Most dental procedures can be performed without stopping aspirin, provided appropriate surgical technique and local hemostasis are used. (Canadian Cardiovascular Society) 6
Discontinuation may be contemplated only when the patient has a low‑moderate stroke risk (CHADS₂ ≤ 2) and the planned procedure carries an exceptionally high bleeding risk; in such cases aspirin should be stopped for a maximum of 7–10 days. (Canadian Cardiovascular Society) 6
For patients with CHADS₂ ≥ 3 or other high‑risk features, aspirin should be continued peri‑operatively. (Canadian Cardiovascular Society) 6

Continue aspirin at the current dose for routine dental work (extractions, periodontal surgery, implants). (American Heart Association; Chest Society) [1][9]
Employ atraumatic surgical technique and apply local hemostatic measures:
Monitor post‑procedure bleeding; any bleeding encountered is expected to be controllable with the above local measures. (American Heart Association) 1

Routine instructions to stop aspirin before dental procedures are discouraged; clinicians should educate patients that discontinuation is generally unwarranted and may be harmful. (American Heart Association; American College of Cardiology) [1][3]
Patients should be advised to consult their cardiologist before any decision to interrupt antiplatelet therapy, even if another healthcare provider suggests stopping it. (American Heart Association; American College of Cardiology) [1][4]

Only in procedures with exceptionally high bleeding potential—where local measures are likely insufficient—might brief aspirin cessation be justified. (Canadian Cardiovascular Society) 6
In patients with very low cardiovascular/thrombotic risk (e.g., CHADS₂ ≤ 2, no stents, no recent events), aspirin may be stopped for 7–10 days maximum, with re‑initiation approximately 24 hours after hemostasis is achieved. (Canadian Cardiovascular Society) [6][5]