title: Dental surgery in anticoagulated patients--stop the interruption.
abstract: In a literature review, the incidence and morbidity of bleeding complications after dental surgery in anticoagulated patients was compared with embolic complications when anticoagulation was interrupted. Over 99% of anticoagulated patients had no postoperative bleeding that required more than local hemostatic measures. Of more than 5431 patients undergoing more than 11,381 surgical procedures, with many patients at higher than present therapeutic intenational normalized ratio (INR) levels, only 31 (∼0.6% of patients) required more than local hemostasis to control the hemorrhage; none died due to hemorrhage. Among at least 2673 patients whose warfarin dose was reduced or withdrawn for at least 2775 visits for dental procedures, there were 22 embolic complications (0.8% of cessations), including 6 fatal events (0.2% of cessations). The embolic morbidity risk in patients whose anticoagulation is interrupted for dental surgery exceeds that of significant bleeding complications in patients whose anticoagulation is continued, even when surgery is extensive. Warfarin anticoagulation, therefore, should not be interrupted for most dental surgery.
authors.affiliation: Christiana Care Health System, Wilmington, Delaware, USA. Electronic address: WahlDentistry@aol.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wahl
authors.affiliation: University Hospitals Case Medical Center and Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Pinto
authors.affiliation: Public Services Librarian, Edward and Barbara Netter Library, Quinnipiac University, Hamden, Connecticut, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kilham
authors.affiliation: Section of Oral Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Lalla
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D000075202:Contraindications; D017742:Dental Care for Chronically Ill; D006488:Hemostasis, Surgical; D006801:Humans; D006472:Oral Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D019647:Oral Surgical Procedures; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants