Managing Anticoagulation

Effective interprofessional communication is vital when planning surgical procedures in 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 must remain anticoagulated for major oral surgery with high risk of bleeding, a transition to peri-operative heparin should be considered.

References

Beirne OR, Evidence to continue oral anticoagulant therapy for ambulatory oral surgery, Journal of Oral and Maxillofacial Surgery. 2005; 63:540-545.

Dunn AS, Turpie AG, Perioperative management of patients receiving oral anticoagulants: a systematic review. Archives of Internal Medicine. 2003; 163(8): 901-8.

Grines CL et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents. Circulation. 2007; 115: 1-6.

Wahl MJ. The mythology of anticoagulation therapy for dental surgery. The Journal of the American Dental Association. 2018; 149(1): e1-e10. 

Costantinides F et al. Managing patients taking novel oral   anticoagulants (NOAs) in dentistry: a discussion paper on clinical implications. BMC Oral Health. 2016; 16(5): 1-9.

Romond K et al. Dental management considerations for a patient taking dabigatran etexilate: a case report.  Oral Surg, Oral Med, Oral Pathol, Oral Radiol, 2013; 116(3): e191-195.