Which medications have an impact on bleeding time?

The risk of post-operative bleeding as a result of dental procedures can be a serious concern for both patient and dentist. A thorough history should always be taken prior to surgery and in some instances, a consultation with the patient’s physician may also be indicated.

There are several medications that are known to interfere with coagulation.

The 7 A’s

1. ASPIRIN

• Irreversibly inhibits platelet function for the platelet’s life
• Consider discontinuing for 7-10 days prior to surgery depending on patient’s health risk

2. ANTI-INFLAMMATORY MEDICATIONS

• NSAIDs reversibly inhibit platelet function
• Consider discontinuing 3-5 days prior to surgery

3. ANTICOAGULANTS

• Includes warfarin, heparin and low-molecular weight heparin

4. ANTIBIOTICS

• Broad-spectrum antibiotics disrupt the intestinal flora which may affect the production of vitamin K, important for clotting factors

5. ANTICANCER MEDICATIONS

• Chemotherapeutics can reduce the number of circulating platelets

6. ANTIPLATELET DRUGS

• Includes Plavix, Ticlid, Reopro, Integrilin

7. ALCOHOLISM

• In cases of liver disease or dysfunction, the production of clotting factors is reduced

Herbal Medications

Many patients also use over-the-counter herbal supplements which can have an adverse effect on coagulation.

• Gingko Biloba: Taken for depression, vertigo, macular degeneration, mental acuity
• Garlic: Cold prevention, lowering cholesterol
• Feverfew: Treating asthma, arthritis and migraines
• Ginseng: Stimulating immune system, normalizing glucose levels in diabetics, increasing energy/libido
• Chamomile: Antiseptic and anti-inflammatory properties, stress relief

Source: Manual of minor oral surgery for the general dentist (Wiley, 2006)