Managing Anticoagulation

Thromboembolism is three times more likely to occur in patients whose anticoagulation is discontinued than in patients whose anticoagulation was continued through routine dental surgery. Primary care communication with dentists prior to procedures in medically complicated individuals on anticoagulants is vital!

Procedural Recommendations

  • Cleanings, fillings, and simple extractions can be performed without interrupting anticoagulation (traditional vitamin K antagonists, newer direct oral anticoagulants (DOACs), and antiplatelet agents)
  • If receiving single antiplatelet therapy, dual antiplatelet therapy, or acetylsalicylic acid, dental procedures can be performed without interruption.
  • If patients must remain anticoagulated (such as those who have mechanical heart valves) for major oral surgery that carries a high risk of bleeding, a transition to peri-operative heparin should be considered.

Bleeding can be controlled in the following ways:

  • Medication: tranexamic acid, epsilon caproic acid mouthwash, topical thrombin
  • Pressure: absorbable collagen, Surgicel, Gelfoam, tea bags
  • Surgically, if necessary


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