[Platelet aggregation inhibitors and vitamin K antagonists in stomatology and maxillo-facial surgery].
Anti-thrombin, anti-platelet and anti-vitamin K agents are common treatments given for the prevention of thrombotic or embolic events. In oral or maxillofacial surgery, the question is whether oral anticoagulants or anti-platelets should be discontinued or not: temporary interruption could limit the risk of bleeding, but would increase the risk of thrombosis, and inversely. The best risk/benefit ratio must be achieved, but in many cases anti-platelet agents or even anti-vitamin K agents can be continued. In case of "potentially hemorrhagic" oral surgery, anti-platelet agents should be interrupted about ten days before the intervention. Anti-vitamin K agents should be interrupted four days before surgery and if required, replaced by low-molecular weight heparin at preventive or curative doses. In the very large majority of patients however, surgery (avulsion for example) can be performed without interrupting anticoagulation. Data in the literature have demonstrated that despite the theoretical risk of hemorrhage, bleeding is minimal and can be easily controlled by local treatments; the risk of thrombotic or thromboembolic events after discontinuing anticoagulation is much greater. A close collaboration between the dentist, the stomatologist, and the clinician is required to determine whether anti-thrombosis prevention should be continued and whether the anticoagulation level is adapted to the thrombotic risk. Good surgical technique and local anti-hemorrhagic treatment are essential in oral surgery, particularly in patients taking anti-platelets or oral anticoagulants.
Département de Médecine Interne, CHU Rouen, 76031 Rouen Cedex. herve.levesque@chu-rouen.fr
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D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D017742:Dental Care for Chronically Ill / Q000379:methods*; D006801:Humans; D007400:Interprofessional Relations; D006472:Oral Hemorrhage / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D013927:Thrombosis / Q000517:prevention & control; D014081:Tooth Extraction; D014812:Vitamin K / Q000037:antagonists & inhibitors*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K