[Dental extractions in patients taking anticoagulants: is alteration of the anticoagulant regime necessary?].
A major concern in the management of patients under anticoagulants is the potential for excessive bleeding after dental procedures. Recommendations for the administration of oral anticoagulants in conjunction with oral surgery range from complete withdrawal of anticoagulants to the maintenance of an unchanged therapy. Rising evidences show that the alteration of anticoagulation is not necessary for patients with INR of 4 or less previous to tooth extractions. Topical antifibrinolytics as tranexamic acid control successfully alveolar bleeding. It is time to stop interrupting anticoagulant therapy for oral surgery. A theoretical risk of hemorrhage after dental surgery in patients at therapeutic levels of anticoagulation exists but it is minimal and is greatly overweighed by the risk of thromboembolism after alteration of the anticoagulant therapy.
Madrid
Carlos
C
Service de stomatologie et de médecine dentaire, PMU, Rue du Bugnon 44, 1011 Lausanne. carlos.madrid@hospvd.ch
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D014081:Tooth Extraction / Q000009:adverse effects*
D000925:Anticoagulants