Oral surgery in patients on anticoagulant therapy.
OBJECTIVE
Surgery is the main oral healthcare hazard to the patient with a bleeding tendency, which is mostly caused by the use of anticoagulants. The traditional management entails the interruption of anticoagulant therapy for dental surgery to prevent hemorrhage. However, this practice may increase the risk of a potentially life-threatening thromboembolism. Because this issue is still controversial, it is the aim of this paper to review the evidence, to highlight the areas of major concern, and to suggest management regimens for patients on the 3 main types of anticoagulants: coumarins, heparins, and aspirin. MATERIALS REVIEWED: The pertinent literature and clinical protocols of hospital dentistry departments have been extensively reviewed and discussed.


RESULTS
Several evolving clinical practices in the last years have been detected: anticoagulant use is generally not discontinued; oral surgery is performed despite laboratory values showing significant bleeding tendency; new effective local methods are used to prevent bleeding; and patients at risk are referred to hospital-based clinics.


CONCLUSIONS
The management of oral surgery procedures on patients treated with anticoagulants should be influenced by several factors: extent and urgency of surgery, laboratory values, treating physician's recommendation, available facilities, dentist expertise, and patient's oral, medical, and general condition.
Eastman Dental Institute, University College London, University of London, 256 Gray's Inn Road, Lonsion WC1X 8LD, UK. c.scully@eastman.ucl.ac.uk
Crispian
C
Scully
Andy
A
Wolff
D000700:Analgesics / Q000494:pharmacology; D000890:Anti-Infective Agents / Q000494:pharmacology; D000925:Anticoagulants / Q000494:pharmacology; D001241:Aspirin / Q000494:pharmacology; D017742:Dental Care for Chronically Ill; D004347:Drug Interactions; D006493:Heparin / Q000494:pharmacology; D006801:Humans; D019934:International Normalized Ratio; D006472:Oral Hemorrhage / Q000517:prevention & control*; D019647:Oral Surgical Procedures / Q000379:methods; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D014859:Warfarin / Q000494:pharmacology
D000700:Analgesics; D000890:Anti-Infective Agents; D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin; D001241:Aspirin