Anticoagulation Use prior to Common Dental Procedures: A Systematic Review

Abstract

Currently, the number of patients on oral anticoagulation is increasing. There is a paucity of data regarding maintaining oral anticoagulation (especially novel oral anticoagulants) around the time of specific dental procedures. A dentist has three options: either to stop anticoagulation, to continue it, or to bridge with heparin. A systematic review of 10 clinical trials was conducted to address this issue. It was found that continuing anticoagulation during dental procedures did not increase the risk of bleeding in most trials. Although none of the studies reported a thromboembolic event after interruption of anticoagulation, the follow-up periods were short and inconsistent, and the heightened thromboembolic risk when stopping anticoagulation is well known in the literature. Heparin bridging was associated with an increased bleeding incidence. We recommend maintaining oral anticoagulation with vitamin K antagonists and novel oral anticoagulants for the vast majority of dental procedures along with the use of local hemostatic agents.

Anticoagulantes Orales de Acción Directa y sus Implicancias en la Exodoncia: Una Revisión Sistemática

“…En cuanto a la literatura disponibles se observa una gran cantidad de estudios que entregan recomendaciones acerca del abordaje para procedimientos dentales, pero son limitados los estudios clínicos que describen la incidencia de hemorragias postoperatorias en pacientes con ACOD en comparación con pacientes sanos o con AVK (Bensi et al, 2018). Cuando un paciente anticoagulado se presenta para un procedimiento dental, el odontólogo tiene tres opciones principales: continuar la misma dosis de anticoagulación oral con agentes hemostáticos locales, disminuir la dosis o interrumpir por completo unos días antes (Chahine et al, 2019). La revisión sistemática (Manfredi et al, 2019), indica que los episodios hemorrágicos presentados en el análisis de 21 estudios que incluían pacientes sometidos a distintos procedimientos dentales invasivos bajo tratamiento con ACOD se consideran menores y manejables con medidas locales, sin necesidad de hospitalización ni transfusiones de sangre.…”

Current practices of Western Australian general dentists regarding management of patients on anticoagulant/antiplatelet therapy

“…However, clinicians should use local haemostatic agents, and assess INR level and renal function. 17 In Western Australia, there are 2600 general dentists currently practising. With increased usage of anticoagulant and antiplatelet medications in Australia, patients on these therapies should be carefully managed especially when performing complex dental procedures.…”

“…Hence, for most dental procedures, VKAs and DOACs must be maintained. However, clinicians should use local haemostatic agents, and assess INR level and renal function 17 …”

Comparative Risk of Bleeding of Anticoagulant Therapy with Vitamin K Antagonists (VKAs) and with Non-Vitamin K Antagonists in Patients Undergoing Dental Surgery

“…As for NOACs, they must also be maintained in most procedures. Local hemostatic agents are mostly needed in both cases [ 14 ]. However, out of 10 studies, only one included patients in therapy with NOACs.…”