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Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2013, vol. 19, book 4
Subject Collection: Oral and Dental Medicine
Pages: 321-326
DOI: 10.5272/jimab.2013194.321
Published online: 09 July 2013
J of IMAB 2013; 19(4):321-326
MANAGEMENT OF PATIENTS ON ANTICOAGULANT THERAPY UNDERGOING DENTAL SURGICAL PROCEDURES. Review Article.
Atanaska Dinkova1
, Donka G. Kirova1, Delyan Delev2
1) Department of Oral surgery, Faculty of Dental Medicine, 2) Department of Pharmacology and Clinical Pharmacology, Medical University Plovdiv, Bulgaria.
ABSTRACT:
Dental treatment performed in patients receiving oral anticoagulant drug therapy is becoming increasingly common in dental offices.
The aim of oral anticoagulant therapy is to reduce blood coagulability to an optimal therapeutic range within which the patient is provided some degree of protection from thromboembolic events. This is achieved at the cost of a minor risk of haemorrhage.
Frequently raised questions concern the safety and efficacy of the various anticoagulation regimens and their accompanying thromboembolic and bleeding risks relative to invasive dental procedures.
The aim of this literature review is to evaluate the available evidence on the impact of anticoagulant medications on dental treatment and highlight certain patient management issues closely interrelated to various aspects of dental treatment.
For that purpose literature search in the electronic database of Medscape, Pubmed-Medline, Science Direct, and EBSCO host, in the data base of Medical University Plovdiv and specialised published books in general medicine and dentistry was made.
A total of 33 publications between 1995 and 2013 were identified: 12 review articles, 11 randomized controlled and non-randomised studies, 6 guidelines and practical guides, 1 meta-analysis and 3 specialised books.
Key words: oral anticoagulants, venous or arterial thromboembolism, bleeding risk, INR, oral surgery, tooth extraction, fibrin sealing, local haemostasis.
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Please cite this article as:
Dinkova A, Kirova DG, Delev D. Management of patients on anticoagulant therapy undergoing dental surgical procedures. Review Article J of IMAB. 2013; 19(4):321-326. doi:10.5272/jimab.2013194.321.
Correspondence to: Atanaska Dinkova, DMD, DDS; Department of Oral surgery, Faculty of Dental Medicine, Medical University Plovdiv, Bulgaria. dinkova_asia@yahoo.com
REFERENCES:
1. Firriolo EJ, Hupp WS. Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. Surg Oral Med Oral Pathol Oral Radiol. 2012 Apr;113(4):431–441. [PubMed] [CrossRef]
2. Broomhead RH, Mallett SV. Clinical aspects of coagulation. Anaesthesia & IntensiveCare Medicine. 2010 May;11(5):195–199. [CrossRef]
3. PL Detail-Document, Managing Anticoagulant and Antiplatelet Drugs Before Dental Procedures. Pharmacist’s Letter/Prescriber’s Letter. May 2011.
4. Popiliev Il. Clinical and therapeutic guide of Cardiology. Medical Publishing House “Raikov” 2002. P. 233-238 [in Bulgarian]
5. Manolov P, Belovejdov N, Monova D. Handbook of Drug Therapy. Publishing house “Svetovit” 2007 [in Bulgarian]
6. Sanz M. Screening for international normalized ratio in the dental office may provide useful information to prevent both hemorrhagic and thromboembolic events. J Evid Based Dent Pract. 2012 Sep;12(3):164-6. [PubMed] [CrossRef].
7. Shamoun FE, Martin EN, Money SR. The novel anticoagulants: The surgeons’ prospective. Surgery. 2013 Mar;153(3):303–307. Epub 2012 Dec 4. [PubMed] [CrossRef]
8. Sié P, Samama CM, Godier A, Rosencher N, Steib A, Llau JV, et all. Surgery and invasive procedures in patients on long-term treatment with direct oral anticoagulants: Thrombin or factor-Xa inhibitors. Recommendations of the Working Group on perioperative haemostasis and the French Study Group on thrombosis and haemostasis. Arch Cardiovasc Dis. 2011 Dec;104(12):669-76. Epub 2011 Oct 29. [PubMed] [CrossRef]
9. Steffel J, Braunwald E. Novel oral anticoagulants: focus on stroke prevention and treatment of venous thrombo-embolism. Eur Heart J. 2011 Aug;32(16):1968–1976. [PubMed] [CrossRef]
10. Thomas TF, Ganetsky V, Spinler SA. Rivaroxaban: An Oral Factor Xa Inhibitor. Clin Ther. 2013 Jan;35(1):4–27. [PubMed] [CrossRef]
11. Airoldi G, Campanini M. Apixaban. Italian Journal of Medicine. 2011 Jun;5(2):128–134. [CrossRef]
12. Aframian DJ, Lalla RV, Peterson DE. Management of dental patients taking common hemostasis-altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar;103 Suppl:S45.e1-11. [PubMed] [CrossRef]
13. Carter G, Goss AN, Lloyd J, Tocchetti R. Current concepts of the management of dental extractions for patients taking warfarin. Aust Dent J. 2003 Jun;48(2):89-96; quiz 138. [PubMed] [CrossRef]
14. Aldous JA, Olson CJ. Managing patients on warfarin therapy: a case report. Spec Care Dentist. 2001 May-Jun;21(3):109-112. [PubMed]
15. Atanasov D. (editor). Oral Surgery. Plovdiv: B.i., 2011; p925. (p232-233). [in Bulgarian]
16. Hong C, Napenas JJ, Brennan M, Furney S, Lockhart P. Risk of postoperative bleeding after dental procedures in patients on warfarin: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Oct;114(4):464-8. [PubMed] [CrossRef]
17. Al-Mubarak S, Al-Ali N, Abou-Rass M, Al-Sohail A, Robert A, Al-Zoman K, et al. Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy. Br Dent J. 2007 Oct 13;203(7):E15; discussion 410-1. Epub 2007 Aug 10. [PubMed] [CrossRef]
18. Lockhart PB, Gibson J, Pond SH, Leitch J. Dental management considerations for the patient with an acquired coagulopathy. Part 2: Coagulopathies from drugs. Br Dent J. 2003 Nov 8;195(9):495-501. [PubMed] [CrossRef]
19. Scully C, Wolff A. Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jul;94(1):57-64. [PubMed] [CrossRef]
20. Perry DJ, Noakes TJ, Helliwell PS; British Dental Society. Guidelines for the management of patients on oral anticoagulants requiring dental surgery. Brit Dent J. 2007 Oct 13;203(7):389-93. [PubMed] [CrossRef]
21. Wahl MJ, Dental surgery in anticoagulated patients. Arch Intern Med. 1998 Aug 10-24;158(15):1610-6. [PubMed] [CrossRef]
22. Kosyfaki P, Att W, Strub JR. The dental patient on oral anticoagulant medication: a literature review. J Oral Rehabil. 2011 Aug;38(8):615–633. Epub 2010 Nov 15. [PubMed] [CrossRef]
23. Pereira CM, Gasparetto PF, Carneiro DS, Corrêa ME, Souza CA.. Tooth Extraction in Patients on Oral Anticoagulants: Prospective Study Conducted in 108 Brazilian Patients. ISRN Dent. 2011; 2011: 203619. [PubMed] Epub 2011 May 29. [CrossRef]
24. Perini A, Bacci C, Maglione M, Mauri P, Di Lenarda R. Dental extractions in patients on anticoagulant therapy. Journal of Cranio-Maxfax Surg. 2008 Sept;36;Suppl 1:S73–S74.
25. Sacco R, Sacco M, Carpenedo M, Mannucci PM. Oral surgery in patients on oral anticoagulant therapy: a randomized comparison of different intensity targets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Jul;104(1):e18-21. Epub 2007 May 7. [PubMed] [CrossRef]
26. Salam S, Yusuf H, Milosevic A. Bleeding after dental extractions in patients taking warfarin. Br J Oral Maxillofac Surg. 2007 Sep;45(6):463-6. Epub 2007 Jan 23. [PubMed] [CrossRef]
27. Steinberg MJ, Moores JF 3rd. Use of INR to assess degree of anticoagulation in patients who have dental procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Aug;80(2):175–177. [PubMed]
28. Nematullah A, Alabousi A, Blanas N, Douketis JD, Sutherland SE. Dental surgery for patients on anticoagulant therapy with warfarin: a systematic review and meta-analysis. J Can Dent Assoc. 2009 Feb;75(1):41-41i. [PubMed]
29. Carter G, Goss A, Lloyd J, Tocchetti R. Tranexamic Acid Mouthwash Versus Autologous Fibrin Glue in Patients Taking Warfarin Undergoing Dental Extractions: A Randomized Prospective Clinical Study. J Oral Maxillofac Surg. 2003 Dec;61(12):1432-5. [PubMed] [CrossRef]
30. Bajkin BV, Todorovic LM. Safety of local anaesthesia in dental patients taking oral anticoagulants: is it still controversial? Br J Oral Maxillofac Surg. 2012 Jan;50(1):65–68. [PubMed] [CrossRef]
31. Meechan GJ, Greenwood M. General medicine and surgery for dental practitioners Part 9: Haematology and patients with bleeding problems. Br Dent J. 2003 Sep 27;195(6):305-10. [PubMed] [CrossRef]
32. Bodner L, Weinstein JM, Baumgarten AK. Efficacy of fibrin sealant in patients on various levels of oral anticoagulant undergoing oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Oct; 86(4):421-4. [PubMed]
33. Mankad PS, Codispoti M. The role of fibrin sealants in hemostasis. Am J Surg. 2001 Aug;182(2 Suppl):21S-28S. [PubMed]
34. Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, et al. EHRA Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J. 2013 Apr 26; [Epub ahead of print] [PubMed] [CrossRef]
Received: 20 March 2013
Published online: 09 July 2013