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Thromboembolic risk and bleeding in patients maintaining or stopping oral anticoagulant therapy during dental extraction
Author(s) -
ALMUBARAK S.,
RASS M. A.,
ALSUWYED A.,
ALABDULAALY A.,
CIANCIO S.
Publication year - 2006
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2006.01825.x
Subject(s) - medicine , warfarin , dental extraction , hemostasis , anticoagulant , surgery , incidence (geometry) , dental surgery , anesthesia , atrial fibrillation , dentistry , physics , optics
thromboembolism (12%), heart valvulopathy (10%), and other indications (3%). All the procedures were carried out by the same oral surgeon. Before undertaking 511 dental extractions (in average four teeth per patient), six fixture insertions and six exeresis of cystic neoformations, patients were randomized to two treatment groups. In group A (mean age 64 ± 11 years), OAT dosage was reduced during the 72 h before surgery to attain INR values between 1.5 and 2.0 (target 1.8) on the day of surgery. The mean INR value actually attained in this group was 1.77 ± 0.26. In group B (mean age 61 ± 12 years), OAT dosage was not reduced, but hemostatic agents such as tranexamic acid, oxidized cellulose or collagen sponges were applied on the surgically treated region. The mean INR measured in this group was 2.89 ± 0.42 on the day of surgery. After 2 h of postsurgical observation, all patients were discharged and received written instructions to avoid nonsteroidal anti-inflammatory drugs (only paracetamol was allowed), to record the length and severity of any bleeding and to contact the center immediately in case of bleeding not controlled by compression for 20 min. Patients in group A were required to restore oral anticoagulant treatment to return to their regular INR on the day after the procedure, while those of group B were asked to continue their regular dosage. All patients were summoned 7 days after the procedure for the removal of the sutures. During this examination, the presence or absence of late bleeding was also recorded. Only patients in group B (OAT not reduced) were instructed to perform mouthwashing with tranexamic acid at home (10 mL for 2 min, four times daily, for 6 days after procedure), and a daily telephonic contact by a nurse was arranged for 6 days after the procedure. Bleeding was considered as an ‘event’ if any intervention by the surgeon was needed to stop it either with a new suture or with placement of other local hemostatic agents. Bleeding successfully managed at home by patients were not considered an event. Bleeding excessive enough to warrant adoption of supplementary local hemostatic measures was observed, in 10 cases (15.1%) in group A (reduced dosage) and in six (9.2%) in group B (unmodified dosage). Bleeding, irrespective of the group, was treated with the insertion of oxidized cellulose inside the procedural area. There was no thrombotic complication in these patients. This randomized study shows that, using simple and inexpensive measures for local hemostasis, it is not necessary to reduce OAT intensity in patients undergoing oral surgery. The adoption of this procedure may prevent thromboembolic complications associated with subtherapeutic INR values.