Management of dental extractions in patients on warfarin and antiplatelet therapy

Lu, Shin-Yu; Lin, Li-Yan; Hsue, Shui-Sang

doi:10.1016/j.jfma.2018.08.019

Cited by 34 publications

(49 citation statements)

References 34 publications

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“…In total, 377 articles were identified via the electronic database search and one article in the hand search. After removing duplicates and screening by title and abstract, 18 papers were included for full-text assessment [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . Two of these were excluded 27,28 and 16 were included for quantitative and qualitative synthesis [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Fig.…”

Section: Study Selectionmentioning

confidence: 99%

Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis

Ockerman

Bornstein

Leung

et al. 2020

International Journal of Oral and Maxillofacial Surgery

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Bleeding is a feared complication of minor oral surgery in patients on treatment with antiplatelet agents and there is no agreed strategy regarding the cessation or not of antiplatelet treatment. The aim of this systematic review was to evaluate bleeding with minor oral surgery in patients on dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT), or no antiplatelet therapy (no APT). The PubMed, Embase, Web of Science, and Cochrane Library databases were screened. Sixteen studies were included. DAPT was continued in all studies. The perioperative bleeding risk was significantly higher for DAPT than for SAPT (risk ratio (RR) 10.16, P = 0.010; risk difference (RD) 0.35, P = 0.269), but not higher compared to no APT (RR 6.50, P = 0.057; RD 0.19, P = 0.060). The postoperative bleeding risk was significantly elevated for DAPT compared to SAPT (RR 2.61, P = 0.010) and no APT (RR 3.63, P = 0.035), but only by 1% (RD 0.01, P = 0.103) and 1% (RD 0.01, P = 0.421), respectively. Clinically, this may be considered quite similar. Additionally, local haemostatic measures could control all reported bleeding and no lethal events occurred. Therefore, DAPT interruption is not advised before minor oral surgery.

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Section: Study Selectionmentioning

confidence: 99%

Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis

Ockerman

Bornstein

Leung

et al. 2020

International Journal of Oral and Maxillofacial Surgery

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“…However, other studies have not found these differences to be statistically significant (18)(19)(20). The percentages of patients suffering post-operative bleeding events was relatively low at between 4.2 and 8.3% for dual antiplatelet therapy compared to control groups (18,20,21). The most important aspect of these studies clinically is that all of the bleeding events were minor and controlled by local measures (16,(18)(19)(20)(21).…”

Section: Clinical Decision-making Based On Key Points From Published mentioning

confidence: 93%

“…The percentages of patients suffering post-operative bleeding events was relatively low at between 4.2 and 8.3% for dual antiplatelet therapy compared to control groups (18,20,21). The most important aspect of these studies clinically is that all of the bleeding events were minor and controlled by local measures (16,(18)(19)(20)(21). The authors drew the conclusion that dual antiplatelet therapy should not be interrupted for dental extractions (16,(18)(19)(20)(21).…”

Section: Clinical Decision-making Based On Key Points From Published mentioning

confidence: 99%

“…The most important aspect of these studies clinically is that all of the bleeding events were minor and controlled by local measures (16,(18)(19)(20)(21). The authors drew the conclusion that dual antiplatelet therapy should not be interrupted for dental extractions (16,(18)(19)(20)(21). As with MRONJ, the SDCEP have also produced guidance for patients taking anticoagulants and antiplatelet drugs (22) and there is also a 'Quick Reference Guide' to accompany the full guidance (23).…”

Section: Clinical Decision-making Based On Key Points From Published mentioning

confidence: 99%

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Managing an Ageing Population: Challenging Oral Epidemiology

et al. 2020

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Global population projections indicate that the proportion of older people is increasing and will continue to do so for the foreseeable future. Many countries are already experiencing the challenges of managing an ageing population, including increased pension contributions from workers, rises to national retirement ages, and spiralling healthcare costs. In oral health terms, in addition to simply an ageing population, epidemiological studies have demonstrated significant changes in the oral health of older adults in recent years. As the numbers of edentulous older adults has declined, there has been a significant increase in the number of partially dentate elderly. Changing attitudes, improved access to dental care and more effective preventative programmes have meant that large numbers of patients are now retaining natural teeth into old age. However, as older patients retain natural teeth for longer, the dental profession is charged with controlling chronic dental diseases in an increasingly challenging oral environment.

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“…The concern around uncontrollable haemorrhage is partly supported by meta-analyses of extractions in patients on dual antiplatelet therapy that found that, rather unsurprisingly, these patients are at an increased risk of bleeding compared to patients who are not taking antiplatelet medications (16,17). However, other studies have not found these differences to be statistically significant (18)(19)(20). The percentages of patients suffering post-operative bleeding events was relatively low at between 4.2 and 8.3% for dual antiplatelet therapy compared to control groups (18,20,21).…”

Section: Clinical Decision-making Based On Key Points From Published mentioning

confidence: 99%

Managing Patients at Risk of Medication Related Complications Requiring Dental Extractions in Primary Care

2020

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When undertaking dental extractions in modern dental practice, two of the complications that have the potential to cause most apprehension for clinicians are the risks of osteonecrosis of the jaws and uncontrollable haemorrhage. This is especially the case when treating older patients because of the increased likelihood of co-morbidities and accompanying polypharmacy which can predispose patients to these problems. Specific medications of concern to practitioners in relation to osteonecrosis risk are antiangiogenic and antiresorptive drugs. Patients taking dual antiplatelet therapy and direct oral anticoagulants require consideration in relation to bleeding risk. With these medications coming increasingly to the forefront over recent years, guidance has been developed by organisations such as the Scottish Dental Clinical Effectiveness Programme (SDCEP). Appropriate use of these guideline should ensure that patients felt to be at particular risk of these complications can frequently be safely managed in primary care. This article aims to provide advice on recognising patients at risk, and to discuss how to utilise key messages within published guidelines when making treatment decisions. The overall intent is to help primary care clinicians who are likely to encounter these patients more and more.

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Management of dental extractions in patients on warfarin and antiplatelet therapy

Cited by 34 publications

References 34 publications

Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis

Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis

Managing an Ageing Population: Challenging Oral Epidemiology

Managing Patients at Risk of Medication Related Complications Requiring Dental Extractions in Primary Care

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