Assessment of bleeding during minor oral surgical procedures and extraction in patients on anticoagulant therapy

Abstract

Introduction:The risk of postoperative hemorrhage from oral surgical procedures has been a concern in the treatment of patients who are receiving long-term anticoagulation therapy. A study undertaken in our institution to address questions about the amount and severity of bleeding associated with minor outpatient oral surgery procedures by assessing bleeding in patients who did not alter their anticoagulant regimen.Subjects and Methods:Eighty-three patients receiving long-term anticoagulant therapy visited Department of Oral and Maxillofacial Surgery from May 2010 to October 2011 for extractions and minor oral surgical procedures. Each patient was required to undergo preoperative assessment of prothrombin time (PT) and measurement of the international normalized ratio. Fifty-six patients with preoperative PT values within the therapeutic range 3–4 were included in the study. The patients’ age ranged between 30 and 75 years. Application of surgispon was done following the procedure. Extraction of teeth performed with minimal trauma to the surrounding tissues, the socket margins sutured, and sutures removed after 5 days.Results:There was no significant incidence of prolonged or excessive hemorrhage and wound infection and the healing process was normal.

Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies

“…According to the guidelines developed at the Academic Centre for Dentistry Amsterdam (ACTA), the INR of the patients taking vitamin K antagonists (which is measured within 24–72 h preoperatively) must be ≤3.5 ( Broekema et al, 2014 ). While other studies have reported that an INR < 4 was a safe range prior to dental surgery ( Evans et al, 2002 ; Bacci et al, 2011 ; Karslı et al, 2011 ; Jimson et al, 2015 ). The INR value was less than 4.2 in nine of the included studies in which the OAT patients were being treated with vitamin K antagonists.…”

“…According to previous reports ( Cannon and Dharmar, 2003 ; Kämmerer et al, 2015 ), minor dental surgery, which is the common procedure in dental health care and routine outpatient treatment, including tooth extractions, dental implant surgery, mucoperiosteal flaps, periodontal surgical procedures, alveoloplasties, limited oral soft tissue surgery, and augmentation procedures (e.g., elevation of the maxillary sinus). Because most of these dental operations can be invasive and hemorrhagic, concern over the safety and efficacy of the OAT and the accompanying bleeding risks related to these invasive dental procedures is unavoidable ( Pototski and Amenabar, 2007 ; Kosyfaki et al, 2011 ; Jimson et al, 2015 ). However, clinical studies evaluating this risk have reported conflicting results.…”

Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations

“…Clinical studies evaluating the risk of bleeding in patients undergoing minor dental surgery procedures have reported conflicting results. Several studies reported that the postoperative bleeding rate in patients undergoing oral anticoagulant treatment, such as warfarin or coumadin, was not higher than that in patients not undergoing oral anticoagulant treatment [ 18 – 20 ]. However, some studies have reported more postoperative bleeding in oral anticoagulant treated patients [ 21 , 22 ].…”

Antiplatelets, Anticoagulants and Its Implications in Dentistry-A Review of Literature

“…• Continue the same dose of oral anticoagulation with local hemostatic agents • Diminish the dose • Interrupt it altogether a few days before [55] Our review has shown that the first option is the best in most of the dental procedures, with none of the 10 studies recommending the remaining two options since no statistically significant difference in postoperative bleeding existed between most groups continuing and interrupting oral anticoagulation. Other studies have also come to the same conclusion: if INR is acceptable and local hemostatic measures adopted properly during the procedure, then there will be no adverse outcome for continuing oral anticoagulation in dental procedures [56][57][58][59][60], provided according to recent literature normal INR values should be 1.1 or less for normal individuals, and patients on anticoagulant therapy should be within 2.0 to 3.0 to carry out surgical dental procedures. It was recommended that vitamin K antagonists must be continued in all surgical procedures if INR is within the therapeutic range.…”