MYTHS OF DENTAL SURGERY IN PATIENTS: RECEIVING ANTICOAGULANT THERAPY
Section snippets
INTERNATIONAL NORMALIZED RATIO
Therapeutic levels of warfarin are measured by the international normalized ratio, or INR, or pro-thrombin time ratio, or PTR (the higher the INR or PTR, the greater the anticoagulant effect).1 In 1992, the American College of Chest Physicians reported that its recommended therapeutic range of continuous anticoagulant is an INR between 2.0 and 3.0 for all conditions except artificial heart valves, for which the recommended INR is between 2.5 and 3.5.2 This statement has been endorsed by the
Myth 1
The first myth is that there are many documented cases of serious bleeding problems resulting from dental surgery in patients receiving therapeutic levels of continuous anticoagulation.
More than 2,400 cases of dental surgical procedures (that is, extractions, alveolar surgery and gingival surgery) performed on more than 950 patients receiving continuous anticoagulant therapy have been documented.5, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42
SUMMARY
Based on a review of the literature, I conclude that there is no need to withdraw continuous anticoagulant therapy for non-surgical or surgical dental procedures if the patient's anticoagulation level is within the currently recommended therapeutic range.
Dental practitioners should prescribe prophylactic or therapeutic antibiotics only when absolutely necessary for patients, particularly those receiving continuous anticoagulant therapy. Concomitantly administered antibiotics may interact
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Risk of bleeding in anticoagulated patients undergoing dental extraction treated with topical tranexamic acid compared to collagen-gelatin sponge: Randomized clinical trial
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2019, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :Two bleeding events (2.4%) were documented. This rate is similar to those reported in comparative studies,4,14,38-40 although several of the prior studies only examined extractions. One study evaluated bleeding episodes in patients taking warfarin while undergoing periodontal procedures.10
Effects of Direct Oral Anticoagulants on Quality of Life During Periprocedural Management for Dental Extractions
2019, Journal of Oral and Maxillofacial SurgeryManagement of dental extractions in patients on warfarin and antiplatelet therapy
2018, Journal of the Formosan Medical AssociationCitation Excerpt :It has been assumed that discontinuing antithrombotic medications for a short period presents negligible risk to the patient. But, the rebound hypercoagulable state with increased thrombin activity after stopping warfarin and progressive recovery of platelet function with excessive thromboxane A2 activity plus decreased fibrinolysis after interrupting aspirin are associated with the risk of thromboembolism,1–6 thereby exposing the patient to a higher risk of recurrent thrombosis, stroke, myocardial infarction (MI), and other coronary events.6–15 Collet et al. reported that nine of 475 MI patients (1.9%) had discontinued aspirin therapy within 15 days prior to intended surgery.12
Awareness and Perception of Dentists in Kuwait Regarding the Dental Management of Patients on Oral Antithrombotic Medications
2023, European Journal of General Dentistry
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Dr. Wahl is in private general practice, 1601 Concord Pike, Wilmington, Del. 19803.