Restor Dent Endod.  2013 Aug;38(3):113-118.

Is stopping of anticoagulant therapy really required in a minor dental surgery?: How about in an endodontic microsurgery?

Affiliations
  • 1Department of Conservative Dentistry, Yonsei University College of Dentistry, Seoul, Korea.
  • 2Microscope Center, Department of Conservative Dentistry, Yonsei University College of Dentistry, Seoul, Korea. andyendo@yuhs.ac

Abstract

Nowadays, oral anticoagulants are commonly prescribed to numerous patients for preventing cardiovascular accident such as thromboembolism. An important side effect of anticoagulant is anti-hemostasis. In a major surgery, the oral anticoagulant therapy (OAT) regimen must be changed before the surgery for proper post-operative bleeding control. However, in a minor dental surgery and endodontic surgery, the necessity for changing or discontinuing the OAT is open to debate. In this study, risks of the consequences were weighed and analyzed. In patients who stop the OAT, the occurrence of thromboembolic complication is rare but the result is fatal. In patients who continuing the OAT, post-operative bleeding can be controlled well with the local hemostatic measures. In the endodontic surgery, there are almost no studies about this issue. The intra-operative bleeding control is particularly important in the endodontic surgery because of its delicate and sensitive procedures such as inspection of resected root surface using dental microscope and retrograde filling. Further studies are necessary about this issue in the viewpoint of endodontic surgery.

Keyword

Anticoagulants; Bleeding control; Endodontic microsurgery; Hemorrhage; Post-operative bleeding; Thromboembolism

MeSH Terms

Anticoagulants
Avena
Hemorrhage
Humans
Thromboembolism
Anticoagulants

Reference

1. Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood. 2012; 120:2954–2962. PMID: 22932800.
Article
2. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R. American College of Chest Physians. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141:e326S–e350S. PMID: 22315266.
3. Wahl MJ. Myths of dental surgery in patients receiving anticoagulant therapy. J Am Dent Assoc. 2000; 131:77–81. PMID: 10649877.
4. Perry DJ, Noakes TJ, Helliwell PS. British Dental Society. Guidelines for the management of patients on oral anticoagulants requiring dental surgery. Br Dent J. 2007; 203:389–393. PMID: 17934422.
Article
5. Sacco R, Sacco M, Carpenedo M, Mannucci PM. Oral surgery in patients on oral anticoagulant therapy: a randomized comparison of different intensity targets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104:e18–e21. PMID: 17482846.
Article
6. Salam S, Yusuf H, Milosevic A. Bleeding after dental extractions in patients taking warfarin. Br J Oral Maxillofac Surg. 2007; 45:463–466. PMID: 17250937.
Article
7. Devani P, Lavery KM, Howell CJ. Dental extractions in patients on warfarin: is alteration of anticoagulant regime necessary? Br J Oral Maxillofac Surg. 1998; 36:107–111. PMID: 9643595.
Article
8. Aframian DJ, Lalla RV, Peterson DE. Management of dental patients taking common hemostasis-altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103(Suppl):S45.e1–S45.e11. PMID: 17379154.
Article
9. Al-Mubarak S, Al-Ali N, Abou-Rass M, Al-Sohail A, Robert A, Al-Zoman K, Al-Suwyed A, Ciancio S. Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy. Br Dent J. 2007; 203:E15. discussion 410-411. PMID: 17694045.
Article
10. Blinder D, Manor Y, Martinowitz U, Taicher S, Hashomer T. Dental extractions in patients maintained on continued oral anticoagulant: comparison of local hemostatic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88:137–140. PMID: 10468454.
Article
11. Carter G, Goss A. Tranexamic acid mouthwash-a prospective randomized study of a 2-day regimen vs 5-day regimen to prevent postoperative bleeding in anticoagulated patients requiring dental extractions. Int J Oral Maxillofac Surg. 2003; 32:504–507. PMID: 14759109.
12. Carter G, Goss A, Lloyd J, Tocchetti R. Tranexamic acid mouthwash versus autologous fibrin glue in patients taking warfarin undergoing dental extractions: a randomized prospective clinical study. J Oral Maxillofac Surg. 2003; 61:1432–1435. PMID: 14663808.
Article
13. Pototski M, Amenábar JM. Dental management of patients receiving anticoagulation or antiplatelet treatment. J Oral Sci. 2007; 49:253–258. PMID: 18195506.
Article
14. Ramström G, Sindet-Pedersen S, Hall G, Blombäck M, Alander U. Prevention of postsurgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants. J Oral Maxillofac Surg. 1993; 51:1211–1216. PMID: 8229393.
Article
15. Souto JC, Oliver A, Zuazu-Jausoro I, Vives A, Fontcuberta J. Oral surgery in anticoagulated patients without reducing the dose of oral anticoagulant: a prospective randomized study. J Oral Maxillofac Surg. 1996; 54:27–32. discussion 323. PMID: 8530996.
Article
16. Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med. 1998; 158:1610–1616. PMID: 9701094.
Article
17. Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod. 2006; 32:601–623. PMID: 16793466.
Article
18. Michaels L. Recurrence of thromboembolic disease after discontinuing anticoagulant therapy. A study of factors affecting incidence. Br Heart J. 1970; 32:359–364. PMID: 5420082.
Article
19. Tulloch J, Wright IS. Long-term anticoagulant therapy; further experiences. Circulation. 1954; 9:823–834. PMID: 13161110.
20. Akbarian M, Austen G, Yurchak PM, Scannell JG. Thromboembolic complications of prosthetic cardiac valves. Circulation. 1968; 37:826–831. PMID: 5300611.
Article
21. Ziffer AM, Scopp IW, Beck J, Baum J, Berger AR. Profound bleeding after dental extractions during dicumarol therapy. N Engl J Med. 1957; 256:351–353. PMID: 13419000.
Article
22. Schmitt J, Ingram RC, Harpole HJ. Hematoma following dental extractions in a patient receiving unreported anticoagulant therapy. Oral Surg Oral Med Oral Pathol. 1960; 13:791–794. PMID: 14443150.
Article
23. Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicillin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 82:610–612. PMID: 8974131.
Article
24. Wood GD, Deeble T. Warfarin: dangers with antibiotics. Dent Update. 1993; 20:350352–353. PMID: 8056109.
25. Campbell JH, Alvarado F, Murray RA. Anticoagulation and minor oral surgery: should the anticoagulation regimen be altered? J Oral Maxillofac Surg. 2000; 58:131–135. discussion 135-136. PMID: 10670590.
Article
26. Madrid C, Sanz M. What influence do anticoagulants have on oral implant therapy? A systematic review. Clin Oral Implants Res. 2009; 20(Suppl 4):96–106. PMID: 19663955.
Article
27. Blinder D, Manor Y, Martinowitz U, Taicher S. Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding. Int J Oral Maxillofac Surg. 2001; 30:518–521. PMID: 11829234.
Article
28. Morimoto Y, Niwa H, Minematsu K. Hemostatic management of tooth extractions in patients on oral antithrombotic therapy. J Oral Maxillofac Surg. 2008; 66:51–57. PMID: 18083415.
Article
29. Bajkin BV, Popovic SL, Selakovic SD. Randomized, prospective trial comparing bridging therapy using low-molecular-weight heparin with maintenance of oral anticoagulation during extraction of teeth. J Oral Maxillofac Surg. 2009; 67:990–995. PMID: 19375008.
Article
30. Al-Mubarak S, Rass MA, Alsuwyed A, Alabdulaaly A, Ciancio S. Thromboembolic risk and bleeding in patients maintaining or stopping oral anticoagulant therapy during dental extraction. J Thromb Haemost. 2006; 4:689–691. PMID: 16460459.
Article
31. Balevi B. Should warfarin be discontinued before a dental extraction? A decision-tree analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110:691–697. PMID: 20580276.
Article
32. Beirne OR. Evidence to continue oral anticoagulant therapy for ambulatory oral surgery. J Oral Maxillofac Surg. 2005; 63:540–545. PMID: 15789328.
Article
33. Martinowitz U, Mazar AL, Taicher S, Varon D, Gitel SN, Ramot B, Rakocz M. Dental extraction for patients on oral anticoagulant therapy. Oral Surg Oral Med Oral Pathol. 1990; 70:274–277. PMID: 2145537.
Article
34. Dunn AS, Turpie AG. Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med. 2003; 163:901–908. PMID: 12719198.
35. Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW. Can warfarin be continued during dental extraction? Results of a randomized controlled trial. Br J Oral Maxillofac Surg. 2002; 40:248–252. PMID: 12054719.
Article
36. Herman WW, Konzelman JL Jr, Sutley SH. Current perspectives on dental patients receiving coumarin anticoagulant therapy. J Am Dent Assoc. 1997; 128:327–335. PMID: 9066217.
Article
37. Sacco R, Sacco M, Carpenedo M, Moia M. Oral surgery in patients on oral anticoagulant therapy: a randomized comparison of different INR targets. J Thromb Haemost. 2006; 4:688–689. PMID: 16460458.
Article
38. Song M, Shin SJ, Kim E. Outcomes of endodontic microresurgery: a prospective clinical study. J Endod. 2011; 37:316–320. PMID: 21329814.
Article
39. Song M, Chung W, Lee SJ, Kim E. Long-term outcome of the cases classified as successes based on short-term follow-up in endodontic microsurgery. J Endod. 2012; 38:1192–1196. PMID: 22892734.
Article
40. Song M, Kim E. Success and failure of endodontic microsurgery. J Korean Acad Conserv Dent. 2011; 36:465–476.
Article
41. Scarano A, Artese L, Piattelli A, Carinci F, Mancino C, Iezzi G. Hemostasis control in endodontic surgery: a comparative study of calcium sulfate versus gauzes and versus ferric sulfate. J Endod. 2012; 38:20–23. PMID: 22152613.
Article
42. Setzer FC, Kohli MR, Shah SB, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature-Part 2: Comparison of endodontic microsurgical techniques with and without the use of higher magnification. J Endod. 2012; 38:1–10. PMID: 22152611.
Article
43. Song M, Kim HC, Lee W, Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod. 2011; 37:1516–1519. PMID: 22000454.
Article
44. Kim Y, Kim S, Shin YS, Jung IY, Lee SJ. Failure of setting of mineral trioxide aggregate in the presence of fetal bovine serum and its prevention. J Endod. 2012; 38:536–540. PMID: 22414845.
Article
45. Chang SW. Chemical characteristics of mineral trioxide aggregate and its hydration reaction. Restor Dent Endod. 2012; 37:188–193. PMID: 23429542.
Article
46. Kang JS, Rhim EM, Huh SY, Ahn SJ, Kim DS, Kim SY, Park SH. The effects of humidity and serum on the surface microhardness and morphology of five retrograde filling materials. Scanning. 2012; 34:207–214. PMID: 22076731.
Article
Full Text Links
  • RDE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr