Perioperative Management of Dental Surgery Patients Chronically Taking Antithrombotic Medications

Abstract

The development of medicine is based not only on the introduction of new methods of treatment, but also on the use of increasingly effective drugs, including antithrombotic drugs. Drugs that inhibit the activity of platelets (antiplatelet and anti-aggregating drugs) and pharmaceuticals that inhibit the activity of plasma coagulation factors (anticoagulants) are used in antithrombotic therapy. In our daily practice we encounter patients who take chronic antiplatelet or anticoagulant drugs. However, more and more often we are dealing with patients who are treated with two antiplatelet drugs, an antiplatelet and an anticoagulant or even undergoing triple antithrombotic therapy. When preparing the patient for invasive craniofacial procedures, it should be assessed whether the temporary discontinuation of antithrombotic treatment due to the fear of excessive perioperative bleeding is justified and will not result in life-threatening thromboembolic complications. The authors discuss in detail the medications used in modern antithrombotic treatment and present a perioperative management procedure with a patient who takes l4 z of these medications chronically.

Relato de uma série de casos de iatrogenias atendidas em um pronto socorro de um hospital público de ensino do oeste do Paraná decorrentes de cirurgias odontológicas ambulatoriais malsucedidas

“…A exemplo, o relato do paciente que apresentou complicação hemorrágica após extração de terceiro molar e fazia uso contínuo de medicação anticoagulante, visto que o profissional responsável pelo ato cirúrgico não realizou uma adequada anamnese, ou se a fez, não solicitou exames complementares para verificar o tempo de coagulação (Índice Normatizado Internacional -RNI e o Tempo de Protrombina -TP) (Manfredini et al, 2021;Wójcik et al, 2022).…”

Knowledge of Practicing Students and Dental Surgeons Regarding Anti- coagulation Therapy of Patients Undergoing Dental Extractions

“…Minor dental surgeries such as tooth extractions are associated with a low risk of bleeding which can be managed with local hemostatic agents 3 . To date, dentists are perplexed about whether to discontinue anticoagulants during extractions or should instead focus on careful monitoring of patients' international normalized ratio (INR)levels and employing local hemostatic measures 4 . A systematic review recommended stopping oral anticoagulants three days before the procedure.…”