Increasing numbers of patients seeking dental care are at heightened thrombotic or thromboembolic risk and are therefore taking either oral antiplatelet (OAP) or oral anticoagulant (OAC) agents that disrupt the coagulation process. In addition, the arsenal of OAP and OAC agents in use has continued to expand as new drug development persists. The impairment of functional coagulation by these agents can lead to prolonged and/or major blood loss from surgical sites during invasive dental procedures. To properly manage these patients perioperatively, sedation and anesthesia providers for dentistry and oral surgery must understand the pharmacokinetics and pharmacodynamics of these agents as well as the factors that influence and augment bleeding and thrombotic risk. Part 1 of this review will present a summary of the coagulation processes and discuss the pharmacokinetic and pharmacodynamic properties of oral antithrombotics currently approved for use in the United States. Part 2 will focus on factors that affect perioperative management of antithrombotic agents with special consideration given to procedures typically encountered when providing sedation and anesthesia in the dental setting.

Part 1 of “Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery” covered the physiological process of hemostasis and the pharmacology of both traditional and novel oral antiplatelets and anticoagulants. Part 2 of this review discusses various factors that are considered when developing a perioperative management plan for patients on oral antithrombotic therapy in consultation with dental professionals and managing physicians. Additionally included are how thrombotic and thromboembolic risks are assessed as well as how patient- and procedure-specific bleeding risks are evaluated. Special attention is given to the bleeding risks associated with procedures encountered when providing sedation and general anesthesia within the office-based dental environment.