An update on the management of anticoagulated patients programmed for dental extractions and surgery (original) (raw)
Dental Procedures in Patients Receiving Oral Anticoagulant Therapy
Acta Clinica Croatica, 2006
There is a widespread belief among physicians and dentists that oral anticoagulant therapy must be discontinued before and for some time after dental procedures. This practice may increase the risk of potentially life-threatening thromboembolism. The present literature does not support routine discontinuation of anticoagulant therapy for dental patients. There is a theoretical risk of bleeding after dental surgery in patients at therapeutic levels of anticoagulation, however, it is minimal and may be greatly outweighed by the risk of thromboembolism upon anticoagulant therapy withdrawal. Thus, dental extractions can be performed without modification of oral anticoagulant therapy. In most patients local hemostasis with gelatin sponge, fibrin glue, sutures and/or mouthwash with tranexamic acid or eaminocaproic acid is sufficient to prevent postoperative bleeding.
Thrombosis and Haemostasis, 2010
Following favourable results from a previous study, a large, multicentre, prospective, case-control study was performed to further assess the incidence of bleeding complications after dental extraction in patients taking oral anticoagulant therapy (OAT). Four hundred fifty-one patients being treated with warfarin who required dental extraction were compared with a control group of 449 non-anticoagulated subjects undergoing the same procedure. In the warfarin-treated group, the oral anticoagulant regimen was maintained unchanged, such that the patients had an International Normalised Ratio ranging between 1.8 and 4, and local haemostatic measures (i.e. fibrin sponges, silk sutures and gauzes saturated with tranexamic acid) were adopted. All the procedures were performed in an outpatient setting. Seven bleeding complications occurred in the OAT group and four in the control group; the dif-ference in the number of bleeding events between the two groups was not statistically significant (OR=1.754; 95% CI 0.510 -6.034; p=0.3727). No post-operative late bleeds requiring hospitalisation and/or blood transfusions were recorded, and the adjunctive local haemostatic measures were adequate to stop the bleeding. The results of our protocol applied in this large, multicenter study show that dental extractions can be performed easily and safely in anticoagulated outpatients without any modification of the ongoing anticoagulant therapy, thus minimising costs and reducing discomfort for patients.
Dental extraction for patients on oral anticoagulant therapy
Oral surgery, oral medicine, and oral pathology, 1990
Dental extraction in patients receiving long-term oral anticoagulant therapy is a controversial issue. Continuation of anticoagulation exposes the patient to serious hemorrhage, whereas cessation of therapy increases the risk of thromboembolism. Forty patients treated by coumarin underwent 63 tooth extractions, without a change in the therapeutic protocol of anticoagulation. The biologic adhesive Beriplast was used successfully to achieve local hemostasis at the site of the surgical wound. Apart from one patient who had mild oozing, there were no incidences of postsurgical hemorrhage.
ISRN Dentistry, 2011
Introduction. Dental treatment performed in patients receiving continuous oral anticoagulant drug therapy is becoming increasingly common in dental offices. For these patients it is imperative to carry out careful anamnesis, as well as a multiprofessional clinical evaluation with regard to the risk and control of hemorrhagic or thromboembolic episodes.Objectives and Material and Methods. The aim is to evaluate postextraction hemorrhagic or thromboembolic episodes in patients who have been on anticoagulant medications for an uninterrupted period of 48 months.Results. Among the 108 patients evaluated, 215 extractions were performed in which there was only one case of postoperative bleeding. Warfarin was used by 98 patients; Warfarin associated with salicylic acetic acid by 9 patients and salicylic acetic acid in only 1 patient. As regards the serologic tests performed, International Normalized Ratio (INR) ranged from 0.8 to 4.9, with a mean of 3.15.Conclusion. Extractions in patients ...
Journal of dental and maxillofacial surgery, 2019
Patients with specific cardiovascular disorders are commonly treated by anti-coagulant medications. Hence, these anti-coagulant drugs might affect greatly the oral health care procedures and the course of dental treatments, Dental Professionals are therefore responsible to treat such patients in a harmonious way as adequate hemostasis is challenging as part of routine oral surgery and other dental procedures. The objective of this review was to discuss the evidence-based practice guidelines based on available literature to manage patients with anti-coagulants therapy seeking invasive dental procedures. According to the available literature, the evidence-based guidelines for anticoagulants such as Warfarin are well established. However, there is insufficient evidence available for new oral anticoagulants drugs. Nevertheless, risk assessment and the standard INR value should be considered in relevance to consultation with the patient's physician must be taken into an account before any elective surgical procedures. Anticoagulant therapy must not be interrupted in patients undergoing minor surgical procedures. However, Local hemostatic measures are of utmost considerations and are effective in achieving hemostasis.
Journal of Oral and Maxillofacial Surgery, 2019
Direct oral anticoagulants (DOACs) have many advantages over warfarin regarding the peri-procedural management for dental extractions. They avoid the need to assess and possibly adjust warfarin therapy to achieve an appropriate hemostatic status before and after extraction. This study aimed to evaluate the real-life data regarding quality of life (QoL) and burden for patients with atrial fibrillation receiving long-term treatment with warfarin or DOACs during peri-procedural management for dental extraction. Methods: The investigators implemented a multi-center study. The sample was composed of 205 patients who were using long-term anticoagulation treatment with warfarin (n=133) or DOACs (n=72). The Duke Anticoagulation Satisfaction Scale (DASS) was used to assess the QoL. Peri-procedural management for dental extraction was recorded using the questions designed by the investigators. Results: Warfarin created a significantly greater burden for patients during peri-procedural management for dental extraction than did using DOACs. The DASS results showed that the QoL of patients was significantly better for the DOAC group than for the warfarin group (75.19±18.52 and 90.12±17.28, respectively; P=0.0001). Forty-five patients in the DOAC group who used warfarin as their previous therapy also underwent another tooth extraction while using warfarin. Of these patients, 91.1% picked DOACs as an anticoagulant of choice in terms of dental extraction. Conclusion: The present findings suggest that DOACs had many advantages over warfarin regarding the reported QoL and peri-procedural management of dental extraction.