Oral surgery in patients undergoing oral anticoagulant therapy.
There is an evident need for procedural protocol for oral surgery patients who undergo oral anticoagulant treatment (OAT) because of: 1) the possible severity of complications and 2) the growing demand for OAT, which in some cases may be as much as 8% of the oral surgery patients that are referred to the hospital from primary care centers. In this study, the authors define the parameters for creating a proto- col applicable to this group of patients. The conclusion is that it is not necessary to suspend OAT before surgery; rather, these procedures should be performed under multidisciplinary medical control.


OBJECTIVE
The authors demonstrate that it is possible to perform oral surgery on OAT patients, without having to sus- pend treatment beforehand.


METHODS
A longitudinal study was performed in OAT patients that required some type of oral surgical procedures. After an INR control, the patient underwent surgery and afterwards the patient was given tranexamic acid as a mouth rinse. Postoperative hemorrhage was classified as slight when it lasted less than 5 minutes, moderate when it lasted longer than five minutes, and severe when it required blood transfusion.


RESULTS
The study was performed over a 5-year period (1996-2000), by the maxillofacial surgery department. In that time period, 125 patients with OAT were treated; 90 of them were males and 35 were females. Tooth extraction was per- formed in 229 sessions and a total of 367 teeth were extracted, with an average of 1.6% per session. With regards to postoperative hemorrahage, it was slight in 210 cases (91.7%), moderate in 18 (7.9%) and severe only in one case (0.4%). All the variables were compared and no statistically significant differences were found.


CONCLUSIONS
We believe that OAT should not be suspended before oral surgery, but it surgery should be performed under multidisciplinary control-especially in the case of the elderly (over 65) or with those patients that have other concomitant illnesses such as renal insufficiency or anemia or other medical treatments.
Vicente Barrero
Mario
M
Servicio de Estomatología, Cirugia Oral y Maxilofacial Hospital Universitario Insular Gran Canaria, Spain. mvicente@idecnet.com
Knezevic
Milan
M
Tapia Martín
Manuel
M
Viejo Llorente
Aurora
A
Orengo Valverde
Juan Carlos
JC
García Jiménez
Francisco
F
López Pérez
Omar
O
Domínguez Sarmiento
Sergio
S
Díaz Cremades
Jose Manuel
JM
Castellano Reyes
Juan
J
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D019934:International Normalized Ratio; D008137:Longitudinal Studies; D008297:Male; D019647:Oral Surgical Procedures; D013223:Statistics as Topic
D000925:Anticoagulants