How do blood thinners affect implant surgery?
Blood thinners can make the site bleed for somewhat longer after an implant is placed, but this bleeding can usually be controlled with local measures. The medicines commonly called “blood thinners” do not thin the blood; they slow clotting, and they do so in two different ways. Anticoagulants act on the clotting system, while antiplatelet drugs stop blood platelets from clumping together. The preparation differs accordingly.
A 2021 meta-analysis in the International Journal of Implant Dentistry (Dawoud et al.), covering 1,467 people in eight studies, found that patients who continued their anticoagulant had about 2.3 times the risk of bleeding; the bleeding was not clinically serious, however, and the authors consider that simple local measures can reduce the risk.
Stopping the medicine has its own price. The SDCEP guidance makes weighing the bleeding risk against the risk of a clot, which the medicine is there to prevent, the decisive test; interrupting warfarin can lead to a serious thromboembolic event. Most patients are therefore treated while continuing their medicine, and the surgery is planned around it. The general requirements for implants are described on our dental implants page.
What does the guidance recommend for each medicine?
The 2022 SDCEP guidance classes implant surgery in which the gum is lifted as a procedure with a higher risk of bleeding. The table gives the usual approach it describes.
| Group of medicines | Examples | Usual approach according to SDCEP |
|---|---|---|
| Vitamin K antagonists | Warfarin, phenprocoumon, acenocoumarol | Treat without interruption if the INR is below 4; postpone if it is 4 or above |
| Direct oral anticoagulants (DOACs) | Apixaban, dabigatran, rivaroxaban, edoxaban | For higher-risk procedures, adjust only the dose on the day of treatment |
| Antiplatelet drugs | Aspirin, clopidogrel, prasugrel, ticagrelor | Continue single and dual therapy without interruption |
Injectable heparins are dealt with separately in the SDCEP guidance; be sure to mention such a medicine at the preliminary assessment. The table is a general framework. Where an anticoagulant is combined with an antiplatelet drug, or where liver, kidney or bone marrow disease raises the bleeding risk, SDCEP recommends consulting the prescribing doctor.
Why does the INR matter on warfarin?
The INR shows how quickly your blood clots and is used to monitor the dose of vitamin K antagonists such as warfarin. According to the SDCEP patient leaflet, your dentist will want to see recent INR results and may ask for a test shortly before the procedure.
SDCEP advises that the INR should ideally be checked no more than 24 hours before the procedure; for patients whose INR has been stable for a long time, a result from up to 72 hours before is acceptable. If the value is below 4, treatment goes ahead without stopping the medicine; at 4 or above it is postponed. The NHS warfarin page advises showing your anticoagulant alert card before any medical or dental treatment and not stopping the medicine unless a doctor tells you to.
What about direct oral anticoagulants (DOACs)?
With apixaban, dabigatran, rivaroxaban and edoxaban, no INR is measured; according to SDCEP, the test is not suitable for these medicines, and routine blood monitoring is not needed. For procedures with a low bleeding risk, the guidance recommends no change to the way the medicine is taken.
For higher-risk procedures such as implant surgery, SDCEP describes an adjustment that depends on the medicine and affects only the morning of treatment: with apixaban and dabigatran the morning dose is missed, with rivaroxaban and edoxaban it is delayed, and people who take these in the evening change nothing. According to the SDCEP patient leaflet, in such a case you are told exactly when and how to take the medicine. This instruction comes only from your treating team; never skip a dose on your own. The NHS apixaban page advises continuing the medicine unless told otherwise.
Do aspirin and other antiplatelet drugs have to be stopped?
No. The SDCEP guidance recommends treating patients on single or dual antiplatelet therapy without interruption, and notes that bleeding can last up to an hour when two drugs are taken. The NHS page on low-dose aspirin advises continuing it unless a doctor stops it.
The choice of painkiller also matters. According to SDCEP, painkillers such as aspirin, ibuprofen and diclofenac can increase bleeding, so ask which painkiller you may take after implant surgery. What to expect in the days after the procedure is described in our guide Do dental implants hurt?
Which local measures reduce bleeding?
For patients on blood thinners having procedures that bleed, the SDCEP guidance lists these measures:
- Timing: the procedure is scheduled early in the day and early in the week, leaving time to manage prolonged bleeding.
- Limited start: a smaller area is treated first and the bleeding assessed before continuing.
- Staged treatment: if necessary, procedures are spread over several appointments, for example when many implants are planned.
- Sutures and haemostatic packing: suturing the wound and resorbable haemostatic materials such as oxidised cellulose or collagen sponge are strongly recommended.
- No discharge with active bleeding: you leave the clinic only once the bleeding is under control.
- Written advice: you receive instructions for the period afterwards and an emergency contact.
According to the SDCEP post-treatment advice, you should not rinse on the day of treatment, should avoid hot drinks and hard foods, and should not chew on the treated side.
What does this mean for treatment in Türkiye?
The most important conversations take place before you travel. At the preliminary assessment, send us on WhatsApp a complete list of your medicines with the active ingredient and dose, the reason you take the blood thinner and, if you have one, your anticoagulant alert card. Also talk to the doctor at home who prescribed the medicine about the planned implant surgery; a change to your medication is decided only together with that doctor, never by you alone and never on the day of treatment.
Because SDCEP says an INR result should be no more than 24 to 72 hours old, a test taken days before your flight is usually not enough; ask at the preliminary assessment how the test before surgery will be organised. Allow enough days in Türkiye after surgery so that any bleeding can be managed at the clinic, and ask before booking your return flight when flying is safe for you. Once you are home, a local dentist or emergency dental service is the first place to go for bleeding that does not stop; let us know on WhatsApp as well. Our page on aftercare and follow-up and our guide How many days do I need to stay in Türkiye for dental implants? explain more.
How do we plan implant surgery on blood thinners at Rönesans?
At the examination in our clinic in Serdivan, we discuss your blood thinner, the reason you take it and your other medicines together with your medical history. We assess the bone with a cone-beam CT (CBCT) scan. Our dentists review your case together, and you know from the start who will treat you. If your medicine needs adjusting, this is decided together with your prescribing doctor.
Before treatment starts, you receive a written treatment and cost plan that lists the treatment tooth by tooth. You can reach us on WhatsApp at +90 532 363 49 54 or by phone on +90 264 606 09 43; during opening hours we reply to messages in English and German within 15 minutes. Follow-up after treatment follows a defined process, and when you leave you receive a copy of your treatment summary and copies of your X-rays for your doctors at home.