Dental and Oral Surgery in Cardiac Patients: In Which Situations Is Surgery Performed? Are Medications Discontinued?

Oral, dental, and maxillofacial surgery procedures in cardiac patients require special planning. In particular, conditions such as coagulation disorders, blood thinners, stents, and heart valve diseases are decisive in shaping the surgical approach.

In this article, we discuss in detail which cardiac patients need a special approach in dental surgery, in which cases medications are or are not discontinued, and how long one should wait before the operation.

Why Do Cardiac Patients Need a Special Approach in Dental Surgery?

There are two fundamental risks during surgical procedures in cardiac patients:

• Bleeding risk: Due to blood-thinning medications (Aspirin, Plavix, Xarelto, Eliquis, etc.).
• Infection risk: In some heart valve patients, even after a simple dental procedure, bacteria mixing into the blood can increase the risk of endocarditis.

Therefore, the treatment plan should be created jointly within the cardiologist – oral surgeon – patient triangle.

In Which Heart Diseases Should Caution Be Exercised Before Dental Surgery?

The following heart problems require a more specialized approach during dental surgeries:

1. Patients with Stents

Post-stent medications are usually in the form of dual antiplatelet therapy (such as Aspirin + Plavix).

• First 6 months: Unless it is an emergency, surgery is not recommended.
• If a vital tooth extraction is required: Medication is NOT DISCONTINUED; local bleeding control is ensured.
• Between 6 months and 1 year: Cardiologist approval is mandatory.

2. Heart Valve Patients and Those with Prosthetic Valves

The risk of infection is high in these patients. Even minor procedures like dental scaling may require antibiotic prophylaxis.

• The use of blood thinners (Warfarin) is strict in mechanical valves.
• Warfarin (Coumadin) is generally not discontinued; INR monitoring is performed.
• If necessary, it is regulated so that the INR is between 2 and 3.

3. Patients with Heart Failure

• Long and stressful procedures are not recommended in moderate-to-advanced heart failure.
• The procedure is divided into short sessions.
• Oxygen support is kept ready in the physician’s environment.

4. Rhythm Disorders (Arrhythmia)

Some medications may interact with local anesthetics. Therefore, anesthetics that do not contain adrenaline should be preferred.

Are Blood Thinning Medications Discontinued Before Surgery?

General Rule: In cardiac patients, medication is not discontinued as much as possible. Discontinuing them increases the risk of clot formation and can be life-threatening.

Evaluation by Medication:

• Aspirin (ASA): Generally NOT DISCONTINUED. Local bleeding control is sufficient.
• Clopidogrel (Plavix): If used alone, it is not discontinued in most procedures. If used with Aspirin, a cardiologist’s evaluation is important.
• NOAC group (Eliquis, Xarelto, Pradaxa): Can be continued without discontinuation in minor surgeries. If extensive surgery is required, a discontinuation plan for 24–48 hours prior is made together with the cardiologist.
• Warfarin (Coumadin): The procedure is planned according to the INR value. In most cases, the procedure can be performed with an INR between 2 and 3.

In Which Situations Is It Necessary to Wait Before Surgery?

In the following cases, the waiting period is of critical importance:

1. Patients with New Stents

• The procedure is postponed for the first 6 months if possible.

2. Procedures After a Heart Attack

• It is necessary to wait at least 6 months after a heart attack for a safe surgical intervention.

3. Those Who Have Undergone New Valve Surgery

• In individuals who have had new valve surgery, one must wait 6 months before dental surgery to minimize the risk of infection and complications.

How Is Dental Surgery Made Safer for Cardiac Patients?

An oral and maxillofacial surgeon—for example, Dr. Tansu Uzel—usually applies the following measures:

• Cardiology report before the operation: The patient’s medications, INR values, and stent history are examined in detail.
• Dividing the procedure into short sessions: Especially in patients with heart failure.
• Reducing stress and pain: Slow and controlled anesthesia application, a calm clinical environment.
• Local bleeding control methods: Hemostatic sponge, compression, suturing, tranexamic acid mouthwash.
• Infection control: Antibiotic prophylaxis is applied if necessary.

Examples from Daily Life

• Example 1: “I have a stent, I have to have my tooth extracted.” -> In this case, medications are generally not discontinued. The operation is planned together with cardiology.
• Example 2: “I had valve surgery, can I have dental scaling?” -> Yes, but it is important that at least 6 months have passed since the surgery and antibiotic prophylaxis is applied if necessary.
• Example 3: “I have heart failure, can I have implants?” -> Yes, but the procedure is performed in shorter sessions, and blood pressure–oxygen monitoring is important.

Dental Surgery Is Safe for Cardiac Patients with Correct Planning

Dental surgery procedures for cardiac patients can be performed safely with correct planning and expert physician supervision. The most important part of the surgical process is the cooperation between the cardiologist and the oral surgeon, the correct management of medications, and the control of the infection risk.

Dr. Tansu Uzel manages the treatment process with a safe, comfortable, and scientific approach by evaluating surgical decisions specifically for the individual in cardiac patients. You can contact us immediately for information. You can examine examples of some treatment processes on Instagram.