Carson Beaty
Tamar Rogoszinski
| Carson Beaty | Tamar Rogoszinski |
Carson Beaty, Tamar Rogoszinski
Steven Wang
Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine
Introduction
Anticoagulant medications, especially warfarin, have been used as an effective protective measure for patients at high risk for thromboembolic events. Recently, the introduction of direct thrombin inhibitors or factor Xa inhibitors has allowed for the same level of protection with reduced drug-to-drug interactions. However, both warfarin and direct oral anticoagulants (DOACs) pose a potential source of complication to oral surgery procedures. The objective of this literature review was to assess proper guidelines of perioperative anticoagulant management prior to dentoalveolar surgery.
Methods
A comprehensive search using the Scopus database was conducted to gather articles for use in this literature review. The Patient, Intervention, Comparison, Outcome (PICO) format for this review was: “Can definitive guidelines for management of patients utilizing anticoagulation therapy prior to minor oral surgery procedures be drawn from existing research.” The following keywords were included in the search: Oral surgery, oral anticoagulant therapy (OAT), warfarin, new orally administered anticoagulants (NOAs), direct oral anticoagulants (DOACs). Of the articles that investigated perioperative bleeding complications with use of anticoagulant therapy, commonly reported factors included: postoperative bleeding, delayed bleeding, and other complications relating to thromboembolic events.
Results
From this data, an attempt was made to discern a commonality in reporting measures from each study. However, variation in postoperative measures (pressure hemostasis duration, tranexamic acid, hemostatic matrices) made it impossible to directly relate findings. Some studies did report increased bleeding postoperatively in patients utilizing OAT. However, this bleeding was limited to mostly “oozing” events, and all were non-life-threatening.
Conclusion
For oral surgery procedures, there have been no reports of fatal postoperative bleeding with continuation of OAT. However, there have been reports of fatal thromboembolic incidents after stopping OAT for dental extractions. The international normalized ratio (INR) of ≤ 3 or ≤ 4 can be used to determine if patients taking vitamin K inhibitors are within a safe range before dental extractions. For prevention of postoperative bleeding events, local hemostatic procedures can be used including sutures, local compression, local antifibrinolytic solutions, collagen, or gelatin sponges.