title: Management of dental extraction in patients undergoing anticoagulant treatment. Results from a large, multicentre, prospective, case-control study.
abstract: Following favourable results from a previous study, a large, multicentre, prospective, case-control study was performed to further assess the incidence of bleeding complications after dental extraction in patients taking oral anticoagulant therapy (OAT). Four hundred fifty-one patients being treated with warfarin who required dental extraction were compared with a control group of 449 non-anticoagulated subjects undergoing the same procedure. In the warfarin-treated group, the oral anticoagulant regimen was maintained unchanged, such that the patients had an International Normalised Ratio ranging between 1.8 and 4, and local haemostatic measures (i.e. fibrin sponges, silk sutures and gauzes saturated with tranexamic acid) were adopted. All the procedures were performed in an outpatient setting. Seven bleeding complications occurred in the OAT group and four in the control group; the difference in the number of bleeding events between the two groups was not statistically significant (OR=1.754; 95% CI 0.510 - 6.034; p=0.3727). No post-operative late bleeds requiring hospitalisation and/or blood transfusions were recorded, and the adjunctive local haemostatic measures were adequate to stop the bleeding. The results of our protocol applied in this large, multicenter study show that dental extractions can be performed easily and safely in anticoagulated outpatients without any modification of the ongoing anticoagulant therapy, thus minimising costs and reducing discomfort for patients.
authors.affiliation: Department of Medical and Surgical Science, Section of Clinical Dentistry, University of Padova, Padova, Italy. bax-1@libero.it
authors.forename: Christian
authors.initials: C
authors.lastname: Bacci
authors.forename: Michele
authors.initials: M
authors.lastname: Maglione
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Favero
authors.forename: Alessandro
authors.initials: A
authors.lastname: Perini
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Lenarda
authors.forename: Mario
authors.initials: M
authors.lastname: Berengo
authors.forename: Ezio
authors.initials: E
authors.lastname: Zanon
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D019934:International Normalized Ratio; D007558:Italy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016037:Single-Blind Method; D013997:Time Factors; D014081:Tooth Extraction / Q000009:adverse effects*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin