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[Oral surgical procedures during anticoagulant therapy]
D Blinder1, U Martinowitz, L Ardekian
1Dept. of Oral and Maxillofacial Surgery, Chaim Sheba Medical Center, Tel Hashomer.
Harefuah
|May 15, 1996
Summary
Minor oral surgery on patients using anticoagulant therapy is safe without dose reduction. Postoperative bleeding, though possible, can be managed effectively with local measures and medications like tranexamic acid.
Area of Science:
- Oral and Maxillofacial Surgery
- Hematology
- Pharmacology
Context:
- Managing patients on anticoagulant therapy undergoing minor oral surgery presents challenges.
- Coumarin anticoagulants are frequently prescribed, necessitating careful surgical planning.
- Maintaining anticoagulation is crucial for preventing thromboembolic events.
Purpose:
- To evaluate the safety and efficacy of performing minor oral surgery without altering coumarin anticoagulant dosage.
- To assess the incidence and management of postoperative bleeding in this patient cohort.
- To determine factors influencing postoperative bleeding after oral surgery in anticoagulated patients.
Summary:
- A study involving 77 patients on coumarin therapy underwent 168 oral surgical procedures without dose modification.
- Local hemostasis was achieved using silk sutures and, for extractions, Gelfoam.
- Postoperative bleeding occurred in 12 patients but was successfully controlled with gauze pressure, tranexamic acid, biologic glue, or splinting.
- Bleeding was correlated with local inflammation, not the international normalized ratio (INR).
Impact:
- The findings suggest that interrupting anticoagulant therapy for minor oral surgery is generally not justified.
- Tranexamic acid and biologic glue are effective in managing postoperative bleeding.
- This approach can improve patient outcomes and reduce the risks associated with discontinuing anticoagulation.