Randomized, prospective trial comparing bridging therapy using low-molecular-weight heparin with maintenance of oral anticoagulation during extraction of teeth.
OBJECTIVE
To evaluate postoperative bleeding and thromboembolic complications during dental extractions in anticoagulated patients, using 2 different protocols.


METHODS
In total, 214 anticoagulated patients in need of simple dental extractions were randomized into 2 groups. Group A consisted of 109 patients on continuous oral anticoagulation therapy (OAT), with a mean international normalized ratio (INR) of 2.45 +/- 0.54. Local hemostasis in these patients was achieved with resorbable collagen sponges, without wound suturing. Group B consisted of 105 patients on bridging therapy with low-molecular-weight heparin (nadroparin-calcium), with a mean INR of 1.26 +/- 0.11 on the day of the procedure. Neither local hemostatic agents nor suturing of the wound was used in these patients.


RESULTS
Eight (7.34%) patients in group A and 5 (4.76%) patients in group B manifested postextractional bleeding, without statistical significance (chi(2), Yates' = 0.253, P > .05). All cases of hemorrhage were mild and easily controlled using local hemostatic measures. None of the participants in either group experienced thromboembolic complications.


CONCLUSIONS
In patients receiving OAT with an INR <or=4.0, simple dental extractions can be performed safely without interruption or modification of OAT, using local hemostatic measures. Suturing of the wound should be reserved for cases with a greater extent of surgical trauma, and when primary hemostasis is insufficient. There is no need for bridging therapy with low-molecular-weight heparin in patients undergoing minor dentoalveolar procedures, although this approach can be used in patients with major oral surgical interventions.
Department of Oral Surgery, Dental Clinic of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia. bajkinb@eunet.yu
Branislav V
BV
Bajkin
Stevan L
SL
Popovic
Srecko D J
SD
Selakovic
D000074:Acenocoumarol / Q000008:administration & dosage; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006489:Hemostatic Techniques; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000517:prevention & control / Q000628:therapy; D013923:Thromboembolism / Q000517:prevention & control; D014081:Tooth Extraction; D014859:Warfarin / Q000008:administration & dosage; D055815:Young Adult
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D017762:Nadroparin; D014859:Warfarin; D000074:Acenocoumarol