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patients on Clopidogrel
Started by mmasurf
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Plavix does not affect the PT or PTT as it affect platelet aggregation. As far as stopping before extractions, i am unsure, I am not a dentist yet...but I would say definately NO if they had a stent placed in the last year for an MI.
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Get a med consult if it makes you feel better. If Im taking out 1-2 teeth or having hygiene do SRP, im not concerned. You can always place gelfoam, collagen plug, or open a larger buccal advancement flap and suture for primary closure. Have them bite on a tea bag. Id much rather risk a bit more bleeding than get sued because they threw a clot and had stopped taking their meds for a simple ext.
You may want to investigate more on why they're taking that med. Any recent cardio events or has the patient been on it for a while? For 1-2 extractions I wouldn't worry too much. Like chfried said, it's nothing some gel foam, sutures, and lots of pressure, won't solve.
Just be aware that the socket may end up gushing blood so don't get flustered. The first time this happened to me, the suction had trouble keeping up with the blood flow, it was so bad. I just shoved a bunch of gel foam in there, sutured her up as best as I could and just held a bunch of gauze there until the bleeding stopped. I was sweating bullets but it turned out fine.
Just be aware that the socket may end up gushing blood so don't get flustered. The first time this happened to me, the suction had trouble keeping up with the blood flow, it was so bad. I just shoved a bunch of gel foam in there, sutured her up as best as I could and just held a bunch of gauze there until the bleeding stopped. I was sweating bullets but it turned out fine.
With plavix you'll have problems forming the platelet plug. But with some local measures (pressure and anything else you want to throw into the socket) you'll get past the initial gush and the fibrin clot will form pretty quickly.
In contrast to Plavix (or aspirin aggrenox, etc), the (theoretical) problem with blood thinners that work on the fibrin cascade (heparin, coumadin, etc) is that you form your initial plug but the clot is slow to mature because the drugs are inhibiting fibrin formation. So in these patients, you might seem like you have good hemostasis and then the patient rubs the area with their tongue and GUSH they start bleeding again. And this might happen after they've gone home... oops!
In practice, I've never stopped plavix or aspirin. We took a tooth out on someone with platelets at 35. However, I've refused to do surgery with high INRs (north of 3 for elective perio surgery and north of 4 for single, painful tooth extraction) and I have bridged with heparin. But understanding WHY you're doing something is important - this way your decision can be case-specific and not dogmatic.
In contrast to Plavix (or aspirin aggrenox, etc), the (theoretical) problem with blood thinners that work on the fibrin cascade (heparin, coumadin, etc) is that you form your initial plug but the clot is slow to mature because the drugs are inhibiting fibrin formation. So in these patients, you might seem like you have good hemostasis and then the patient rubs the area with their tongue and GUSH they start bleeding again. And this might happen after they've gone home... oops!
In practice, I've never stopped plavix or aspirin. We took a tooth out on someone with platelets at 35. However, I've refused to do surgery with high INRs (north of 3 for elective perio surgery and north of 4 for single, painful tooth extraction) and I have bridged with heparin. But understanding WHY you're doing something is important - this way your decision can be case-specific and not dogmatic.
