Oral surgery in patients under antithrombotic therapy. Narrative review.
Abstract
Aging population and increase of cardiovascular diseases have raised the number of patients receiving antithrombotic therapy in elective or emergency dental care, including surgical procedures. The aim of this article is to review the evidence and clinical guidelines published in the past five years for dental management of patients on antithrombotic therapy. The American Antithrombotic Therapy Guideline - 2012 - generally recommends not to suspend antiplatelet or anticoagulant treatment in dental procedures since they are considered to have low bleeding risk and easy resolution. In the dental area there is ample published evidence regarding oral surgical procedures management, especially by maxillofacial surgeons. Low number of complications associated with extractions or other minor surgeries of the oral cavity, without suspending antithrombotic drugs and only taking some minimum safeguards, such as healing by first intention or the use of some local hemostatic agents, have been shown. Overall, patients under chronic antithrombotic therapy should maintain their medications when undergoing low and medium complexity dental procedures, since complications are minor and easy to handle. Due to the interactions between them, particular care should be taken with patients using more than one drug.References
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2. Fakhri HR, Janket SJ, Jackson EA, Baird AE, Dinnocenzo R, Meurman JH. Tutorial in oral antithrombotic therapy: biology and dental implications. Med Oral Patol Oral Cir Bucal. 2013; 18(3): e461-72.
3. Berkovits A, Aizman A, Zúñiga P, Pereira J, Mezzano D. Nuevos anticoagulantes orales. Rev Med Chile 2011; 139(10): 1347-1355.
4. Pedemonte C, Montini C, Castellón L. Manejo de pacientes en tratamiento con anticoagulantes orales previo a cirugía oral. Rev Dent Chile 2005; 96(2): 18-23.
5. Arzamendi D, Freiza X, Puig M, Heras M. Mecanismo de acción de los fármacos antitrombóticos. Rev Esp Cardiol. 2006; 6(Supl. H): 2-10.
6. HolbrooK, AM, Pereira JA, Labiris R et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med. 2005; 165: 1095-1106.
7. Romero R, Vargas P, Letelier V. Warfarina versus Acenocumarol en alcanzar niveles terapéuticos en una población ambulatoria. Rev Chil Cardiol. 2009; 28(4): 375-9.
8. Thijssen, HH, Flinois JP, Beaune PH. Cytochrome P4502C9 is the principal catalyst of racemic acenocoumarol hydroxylation reactions in human liver microsomes. Drug Metab Dispos. 2000; 28(11): 1284-90.
9. Guyatt G, Akl E, Crowther M, Gutterman D, Schuünemann H. Therapy and Prevention of Thrombosis. 9th Executive Summary: Antithrombotic American College of Chest Physicians. Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: 7S-47S
10. Ortel T. Perioperative management of patients on chronic antithrombotic therapy. Blood 2012; 120(24): 4699-705.
11.- Pérez Y, Muradas M, Sotolongo Y. Anticoagulantes y antiplaquetarios: consideraciones en el paciente quirúrgico. Rev Cuba Anestesiol Reanim. 2011; 10(1): 21-33.
12. Girotra C, Padhye M, Mandlik G, Dabir A, Gite M, Dhonnar R, Pandhi V, Vandekar M. Assessment of the risk of haemorrhage and its control following minor oral surgical procedures in patients on anti-platelet therapy: a prospective study. Int J Oral Maxillofac Surg. 2014; 43(1): 99-106.
13. Lahoti B, Aggarwal G, Diwaker A, Sharma S, Laddha A. Hemostasis during hypospadias surgery via topical application of feracrylum citrate: A randomized prospective study. J Indian Assoc Pediatr Surg. 2010; 15(3): 87–89.
14. Broekema FI, van Minnen B, Jansma J, Bos RR. Risk of bleeding after dentoalveolar surgery in patients taking anticoagulants. Br J Oral Maxillofac Surg. 2014; 52(3): e15-9.
15. Svensson R, Hallmer F, Englesson CS, Svensson PJ, Becktor JP. Treatment with local hemostatic agents and primary closure after tooth extraction in warfarin treated patients. Swed Dent J. 2013; 37(2): 71-7.
16. Benito-Urdaneta M, Benito-Urdaneta M, Bernardoni-Socorro C, Arteaga-Vizcaíno M, Benito-Urdaneta M. Manejo odontológico del paciente con terapia antitrombótica. Acta Odontol Venez. 2009: 47(1).
17. Ripollés-de Ramón J1, Muñoz-Corcuera M, Bravo-Llatas C, Bascones-Martínez A. Tranexamic acid gel in patients treated with oral anticoagulants. Med Clin (Barc). In press.
18. Okamoto T, Ishikawa I, Kumasaka A, Morita S, Katagiri S, Okano T, Ando T. Blue-violet light-emitting diode irradiation in combination with hemostatic gelatin sponge (Spongel) application ameliorates immediate socket bleeding in patients taking warfarin. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 117(2): 170-7.
19. Davis C, Robertson C, Shivakumar S, Lee M. Implications of Dabigatran, a direct thrombin inhibitor, for oral surgery practice. J Can Dent Assoc. 2013; 79: d74.
20. Romond KK, Miller CS, Henry RG. Dental management considerations for a patient taking dabigatran etexilate: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 116(3): e191-5.
21. van Ryn J, Stangier J, Haertter S, et al. Dabigatran etexilateda novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost. 2010;103:1116-1127.
22. Goodchild JH, Donaldson M. A clinically significant drug interaction between warfarin and amoxicillin resulting in persistent postoperative bleeding in a dental patient. Gen Dent. 2013; 61(4): 50-4.
23. Becker DE. Antithrombotic drugs: pharmacology and implications for dental practice. Anesth Prog. 2013; 60(2): 72-9.
24. Napeñas JJ, Oost FC, DeGroot A, Loven B, Hong CH, Brennan MT, Lockhart PB, van Diermen DE. Review of postoperative bleeding risk in dental patients on antiplatelet therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115(4): 491-9.
25. Díaz J, Duque M, Duque L, Uribe W, Medina E, Marín J. Tratamiento perioperatorio del paciente con antiagregación o anticoagulación. Rev Colomb Cardiol. 2012; 19(5): 252-9.
26. Wahl MJ. Dental surgery and antiplatelet agents: bleed or die. Am J Med. In press.
27. Chandler L, Martínez-Sahuquillo A, Bullón P. Valoración del riesgo médico en la consulta dental mediante la encuesta EMRRH. Med Oral Patol Oral Cir Bucal 2004; 9(4): 321-7.
28. van Diermen DE, van der Waal I, Hoogvliets MW, Ong FN, Hoogstraten J. Survey response of oral and maxillofacial surgeons on invasive procedures in patients using antithrombotic medication. Int J Oral Maxillofac Surg. 2013; 42(4): 502-7.
Published
2015-02-13
How to Cite
CARRIZO, Anggelo; CARRASCO, David.
Oral surgery in patients under antithrombotic therapy. Narrative review..
Journal of Oral Research, [S.l.], v. 4, n. 1, p. 58-64, feb. 2015.
ISSN 0719-2479.
Available at: <https://www.joralres.com/index.php/JOralRes/article/view/joralres.2015.012>. Date accessed: 29 apr. 2024.
doi: https://doi.org/10.17126/joralres.2015.012.
Issue
Section
Reviews
Keywords
Antithrombotic, Coagulation, Exodontia, Oral Surgery, Hemorrhage, Aspirin.
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