Anticoagulants & Antiplatelets
Dental Considerations for Patients Taking LMWH (e.g. enoxaparin)
Coordinate timing with prescribing clinician (LMWH)
Treatment-dose LMWH increases bleeding risk. Liaise with the prescribing clinician regarding timing of the dose relative to the procedure.
Emergency vs routine management
If EMERGENCY — what to do
- • Prophylactic dose: proceed with local haemostasis.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- • Treatment dose: consult the prescriber; treat with local haemostatic measures.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- • Use local haemostatic measures: oxidised cellulose/collagen packing, sutures, pressure and tranexamic acid 5% mouthwash.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
If ROUTINE — what to do
- • Plan higher-risk procedures before the next scheduled dose and liaise with the prescriber for treatment-dose regimens.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
Clinical precautions
- • Consult prescribing clinician on dose timing
- • Treat at trough level where possible
- • Local haemostatic measures
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | ROUTINE No bleeding risk for this procedure |
| Supragingival scaling / polish | MODIFY / CAUTION Coordinate timing with prescribing clinician (LMWH) |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Coordinate timing with prescribing clinician (LMWH) |
| Root canal treatment | ROUTINE No bleeding risk for this procedure |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Coordinate timing with prescribing clinician (LMWH) |
| Surgical / bony extraction | MODIFY / CAUTION Coordinate timing with prescribing clinician (LMWH) |
| Implant placement | MODIFY / CAUTION Coordinate timing with prescribing clinician (LMWH) |
References
- SDCEP 2022 — Injectable anticoagulants
- SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.