Anticoagulants & Antiplatelets

Dental Considerations for Patients Taking Ticagrelor

Treat without interruption (ticagrelor)

SDCEP: dental procedures should be carried out without stopping ticagrelor. Use local haemostatic measures; expect slightly prolonged bleeding.

Emergency vs routine management

If EMERGENCY — what to do

• Do not stop the antiplatelet — treat the emergency.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
• Avoid NSAIDs; use paracetamol for analgesia.Ref: SDCEP. Drug Prescribing for Dentistry, 3rd ed. (2016, updated 2021)

If ROUTINE — what to do

• Proceed with routine care without interruption.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
• Never stop antiplatelets after a stent without cardiologist approval (stent-thrombosis risk).Ref: Levine GN et al. 2016 ACC/AHA Focused Update on Duration of Dual Antiplatelet Therapy. Circulation 2016;134:e123–e155
• On dual therapy expect prolonged bleeding: limit the extent of surgery and suture.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022

Clinical precautions

• Do NOT stop ticagrelor
• Local haemostatic measures (pressure, sutures, oxidised cellulose)
• Treat early in the day; stage high bleeding-risk surgery

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 Treat without interruption (ticagrelor)
Deep scaling / subgingival RSD (subgingival calculus)	MODIFY / CAUTION Treat without interruption (ticagrelor)
Root canal treatment	ROUTINE No bleeding risk for this procedure
Simple extraction (1–3 teeth)	MODIFY / CAUTION Treat without interruption (ticagrelor)
Surgical / bony extraction	MODIFY / CAUTION Treat without interruption (ticagrelor)
Implant placement	MODIFY / CAUTION Treat without interruption (ticagrelor)

Get a patient-specific decision in seconds

Combine all conditions, medications, lab results and the planned procedure — with anaesthetic dose calculation, lab requests and a referral letter PDF.

References

SDCEP 2022 — Antiplatelets
SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
SDCEP. Drug Prescribing for Dentistry, 3rd ed. (2016, updated 2021)
Levine GN et al. 2016 ACC/AHA Focused Update on Duration of Dual Antiplatelet Therapy. Circulation 2016;134:e123–e155

This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.