Anticoagulant and antiplatelet combinations

Refer to Section 9 of the full guidance.

For some patients, combinations of anticoagulant and antiplatelet medications are prescribed, including a DOAC or warfarin with aspirin or clopidogrel, or in rare cases, triple drug combinations. Patients with atrial fibrillation and recent myocardial infarction may be taking a DOAC with dual antiplatelet therapy.

Because of the conditions for which combination therapies are prescribed, including coronary stents, the patient’s medication should not be stopped prematurely or interrupted without prior discussion and written advice from the patient’s cardiologist.

Patients on combination therapies are likely to have a higher bleeding risk and may have additional medical complications.

For a patient who is taking an anticoagulant and antiplatelet drug combination and requires dental treatment that is likely to cause bleeding, with either a low or higher risk of bleeding complications (see Bleeding risks for dental procedures):

  • Consult with the patient’s prescribing clinician in order to assess the likely impact of the particular drug combination and the patient’s medical condition on their bleeding risk (see Contacts and referrals).
    • Some patients might only be on these drug combinations for 3-4 weeks so it may be possible to delay dental treatment