1. Effective interprofessional communication is vital when planning surgical procedures for medically complicated individuals on anticoagulants. Thromboembolism when anticoagulation is discontinued is three times more likely to occur than major bleeding if anticoagulation is continued.
Procedural Recommendations
Cleanings, fillings, and simple extractions can be performed without interrupting anticoagulation or antiplatelet agents.
Most procedures can be performed with an INR between 1.8 and 2.5.
Bleeding can be controlled locally utilizing pressure, Surgicel™, tranexamic acid, or topical thrombin.
If patients who must remain anticoagulated require major oral surgery that carries a high risk of bleeding, a transition to perio-operative heparin bridging should be considered.
References
Aframian, D.J., et al. Management of dental patients taking common hemostasis-altering medications. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 2007; 103(1001):S45e1-S45e11. Beirne, O.R. Evidence to continue oral anticoagulant therapy for ambulatory oral surgery, Journal of Oral and Maxillofacial Surgery 2005; 63: Dunn, A.S., Turpie, A.G. Perioperative management of patients receiving oral anticoagulants: a systematic review. Archives of Internal Medicine 2003; 163(8): Grines, C.L., et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents. Circulation 2007; 115:1-6. Wahl, M.J. Myths of dental surgery in patients receiving anticoagulant therapy. Journal of the American Dental Association 2000; 131(1):77-81. 1