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.


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