Whether or not to stop ASA/Plavix/Coumadin depends on the reason for which the patient is taking these medications, the type and location of the intended procedure, the risk of thrombosis if these drugs are withheld for 5-7 days and the consequence of bleeding if it occurs. A little excess bleeding in the brain or eye may have catastrophic consequences and should be avoided, but a little excess bleeding from the mouth or GI tract has little harmful consequence.

Withholding Coumadin prior to tooth extraction isn’t necessary. Well-informed dentists or oral surgeons are willing to extract the tooth, if INR is less than 4.0 (this is allowed in published guidelines for tooth extraction).

Bear in mind that although the risk of thrombosis in a patient with recurrent DVT is high when stopping Coumadin over several months or years, it’s very small during a 5-day holiday from it. Similarly, the risk of recurrent myocardial infarction or stroke during the 7 days that the patient is off aspirin or Plavix is small and you have to weigh this against the risk of bleeding.

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