Frequency of bleeding following invasive dental procedures in patients on low-molecular-weight heparin therapy.
OBJECTIVE
The purpose of this study was to determine the frequency of bleeding complications after invasive dental procedures in patients on low-molecular-weight heparin (LMWH) therapy.


METHODS
A chart review of patients who underwent invasive dental procedures while on LMWH therapy was conducted. The following information was obtained: demographics, medical history, social history, medications, relevant laboratory values, postoperative bleeding events, and use of local hemostatic agents and blood products.


RESULTS
Forty-one patients (21 men) were identified with 42 dental appointments. The mean age was 48 years (range, 16 to 78 years). Thirty-seven patients (90%) were on LMWH therapy for deep venous thrombosis prophylaxis. Thirty-one patients (76%) were on concomitant medications that may potentiate bleeding. Multiple dental extractions (range, 2 to 14 teeth) were performed during 19 dental appointments. Twenty-one appointments were for single-tooth extraction and 2 were for soft tissue biopsies. Three patients (7%) had postextraction bleeding events. All 3 patients were on LMWH (enoxaparin) and warfarin therapy concurrently. One patient had persistent bleeding after extraction of 4 teeth (international normalized ratio, 1.6), which was successfully controlled with topical thrombin, administration of vitamin K and fresh frozen plasma, and discontinuation of enoxaparin and warfarin. Postoperative bleeding in the other 2 patients was managed successfully with local hemostatic measures and home care instructions.


CONCLUSIONS
Our study suggests that, although postoperative bleeding in patients on LMWH therapy alone is rare to nonexistent, patients on warfarin and LMWH may be at increased risk of bleeding after invasive dental procedures.
Pediatric Dentistry, Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC 28203, USA. catherine.hong@carolinashealthcare.org
Catherine H L
CH
Hong
Joel J
JJ
Napeñas
Michael T
MT
Brennan
Scott L
SL
Furney
Peter B
PB
Lockhart
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D017984:Enoxaparin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000209:etiology*; D019647:Oral Surgical Procedures; D010949:Plasma; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D013537:Sutures; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use; D014081:Tooth Extraction; D020246:Venous Thrombosis / Q000517:prevention & control; D014812:Vitamin K / Q000627:therapeutic use; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D017984:Enoxaparin; D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K; D014859:Warfarin; D013917:Thrombin; D001241:Aspirin