03/02/2026
黄德威 / 拔牙前要停抗血小板药吗？关键在风险评估
- 23 January 2026
Should antiplatelet medication be stopped before tooth extraction? The key lies in risk assessment
23 January 2026
Question:
I have coronary artery blockage, but it is not severe. I did not have a stent placed and have only been on long-term cholesterol-lowering medication and the antiplatelet drug clopidogrel for about four to five years. I do not have high blood pressure.
Recently, I need to undergo a tooth extraction. In this situation, do I need to temporarily stop clopidogrel? If so, how many days should it be stopped? Since my next cardiology follow-up is still seven to eight months away and I cannot consult my specialist for now, I hope to seek your advice first. Thank you.
Doctor’s Answer:
This is a very good question. Clinically, when deciding whether to stop antiplatelet medications (such as clopidogrel), doctors usually weigh two types of risk: the risk of cardiovascular events versus the risk of bleeding after tooth extraction.
Generally speaking, if a patient has significant cardiovascular disease, or has previously undergone coronary stent placement or coronary artery bypass surgery, it is usually not recommended to stop clopidogrel on one’s own. Stopping the medication may increase the risk of blood clot formation, potentially leading to a heart attack or stroke.
No stent placed: short-term discontinuation carries lower risk
However, if the coronary blockage is mild and the patient has not had a stent placed or surgery, then under certain circumstances, short-term discontinuation carries a relatively lower risk and does not necessarily lead to serious problems.
As for the tooth extraction itself, if it is a simple and uncomplicated procedure, the risk of post-extraction bleeding is not high, and it is generally not encouraged to stop clopidogrel deliberately. Modern dentistry has well-established local haemostatic techniques and medications that can effectively control bleeding after tooth extraction.
Therefore, whether the medication should be stopped depends on the individual’s cardiovascular condition and the complexity of the tooth extraction. It is recommended to inform the dentist in advance that you are taking clopidogrel, so that the dentist and the attending doctor can jointly assess the risks and make the safest arrangement. Do not stop the medication on your own.
问：我有心脏血管阻塞的问题，但情况不算严重，因此没有放置支架，目前只是长期服用降胆固醇药物及抗血小板药氯吡格雷（clopidogrel），已经大约四五年。我没有高血压。
近期我需要进行拔牙手术，请问在这种情况下，我是否需要暂时停用氯吡格雷？如果需要，应该停几天？由于我的心脏专科复诊还要等七八个月，目前无法咨询主治医生，因此希望先向你请教。谢谢。
医生解答：
这是一个相当好的问题。临床上，在评估是否需要停用抗血小板药物（如氯吡格雷）时，医生通常会权衡两方面的风险，即心血管事件的风险与拔牙后出血的风险。
一般而言，若病人本身有较严重的心血管疾病，曾接受心脏支架置入或冠状动脉绕道手术，通常不建议自行停用氯吡格雷，因为停药可能增加血栓形成，甚至引发心脏病或中风的风险。
未曾置支架 短暂停药风险较低
但若心血管阻塞情况较轻微，未曾放置支架或进行手术，在特定情况下短暂停药，风险相对较低，并非一定会造成严重问题。
至于拔牙手术本身，若属于简单、不复杂的程序，术后出血风险不高，通常也不鼓励刻意停用氯吡格雷。现代牙科已有相当成熟的局部止血技术与药物，可有效控制拔牙后的出血情况。
因此，是否需要停药，应视个人心血管状况与拔牙的复杂程度而定。建议在拔牙前，主动告知牙医目前正在服用氯吡格雷，让牙医与主治医生共同评估风险，作出最安全的安排，切勿自行停药。
