Dentoalveolar Procedures for the Anticoagulated Patient: Literature Recommendations Versus Current Practice

Ward, Brent B.; Smith, Miller H.

doi:10.1016/j.joms.2007.03.003

Cited by 46 publications

(35 citation statements)

References 91 publications

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“…With respect to dental procedures or surgeries, optimal management varies considerably for patients at high risk of thromboembolism receiving long-term OAC 4,5,6. Periprocedural anticoagulation therapy is especially important in patients with MHV receiving long-term OAC, since they have the highest annualized risk of thromboembolic complications in the absence of anticoagulation therapy 2.…”

Section: Discussionmentioning

confidence: 99%

“…However, temporary discontinuation of long-acting OAC drugs (e.g., warfarin) may be inevitable to allow patients with MHV to undergo an invasive dental procedure or surgery. The recommendation for the management of OAC in minor dental procedures such as simple dental extraction has been proposed on the basis of clinical data; however, a consensus on which patients require invasive dental procedures is lacking 4,5,6. In clinical practice, conventional care with a short-acting anticoagulant as "bridge therapy" is commonly used to decrease the risk of thromboembolism during the cessation of OAC therapy 7,8,9.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Cost-Effectiveness of Bridge Therapies for Invasive Dental Procedures in Patients with Mechanical Heart Valves

et al. 2014

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PurposeBridge anticoagulation therapy is mostly utilized in patients with mechanical heart valves (MHV) receiving warfarin therapy during invasive dental procedures because of the risk of excessive bleeding related to highly vascular supporting dental structures. Bridge therapy using low molecular weight heparin may be an attractive option for invasive dental procedures; however, its safety and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain.Materials and MethodsThis study investigated the safety and cost-effectiveness of enoxaparin in comparison to UFH for bridge therapy in 165 consecutive patients (57±11 years, 35% men) with MHV who underwent invasive dental procedures.ResultsThis study included 75 patients treated with UFH-based bridge therapy (45%) and 90 patients treated with enoxaparin-based bridge therapy (55%). The bleeding risk of dental procedures and the incidence of clinical adverse outcomes were not significantly different between the UFH group and the enoxaparin group. However, total medical costs were significantly lower in the enoxaparin group than in the UFH group (p<0.001). After multivariate adjustment, old age (≥65 years) was significantly associated with an increased risk of total bleeding independent of bridging methods (odds ratio, 2.51; 95% confidence interval, 1.15-5.48; p=0.022). Enoxaparin-based bridge therapy (β=-0.694, p<0.001) and major bleeding (β=0.296, p=0.045) were significantly associated with the medical costs within 30 days after dental procedures.ConclusionConsidering the benefit of enoxaparin in cost-effectiveness, enoxaparin may be more efficient than UFH for bridge therapy in patients with MHV who required invasive dental procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety and Cost-Effectiveness of Bridge Therapies for Invasive Dental Procedures in Patients with Mechanical Heart Valves

et al. 2014

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“…Surveys of Oral and Maxillofacial Surgeons and Dermatologists revealed that 24% to 71% recommend discontinuing warfarin therapy before their procedures. 6,7 Even more compelling is a prospective registry of patients undergoing cataract surgery in the United States and Canada, which found that more than one-fourth of patients interrupted warfarin therapy before their cataract surgery. 10 These interruptions are not without consequence.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Unfortunately, surveys of physicians and dentists have shown that warfarin is often inappropriately interrupted for procedures, in contradiction to guideline statements. 6,7 Previous studies have shown that periprocedural interruptions of warfarin therapy result in up to a 1% risk of thromboembolism. 8,9 However, the frequency and guideline concordance of warfarin therapy interruptions due to dental and medical procedures are not well known.…”

mentioning

confidence: 99%

Guideline-Discordant Periprocedural Interruptions in Warfarin Therapy

Skolarus

Morgenstern

Froehlich

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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Background-Periprocedural interruptions in warfarin therapy increase thromboembolic risks to patients and are not indicated for all procedures. We sought to determine the frequency and guideline concordance of periprocedural warfarin interruptions to inform a future educational intervention. Methods and Results-In October and November of 2009, an anonymous postal survey was sent to all patients followed for more than 1 year by the University of Michigan Anticoagulation service. Patients were asked how many times in the prior year they were requested to interrupt warfarin therapy for a medical or dental procedure or test and the specific indication for the requested interruption in warfarin therapy. A total of 1686 of 2133 (79%) subjects responded. The mean age of respondents was 69 years (SDϭ14 years). The majority were men (56%) and white (93%). Atrial fibrillation was the most common indication for warfarin therapy (nϭ966, 57%). At least 1 request to interrupt warfarin therapy in the prior year was given by 819 of 1648 (50%) respondents, including 481 of the 947 (51%) respondents taking warfarin for atrial fibrillation. Forty-eight percent of requests to interrupt warfarin among all respondents and 50% of requests to interrupt warfarin among those taking warfarin, specifically for atrial fibrillation, were for indications not supported by guideline statements. Conclusions-Periprocedural

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“…1,[5][6][7][8][9][10][11][12][13][14] Absorbable gelatin sponges, oxidized cellulose, fibrin glue, and collagen sponges have been the most frequently used local hemostatic agents, and they have all shown to be effective without significant differences. 7,[15][16][17][18][19] A new adhesive agent, HemCon Dental Dressing (HDD) (Zimmer Holdings, HemCon Medical Technologies, Inc., Beaverton, OR), has been recently introduced into oral surgery and already used for tooth extractions in patients taking antithrombotic drugs. 20,21 It derives from the agent used by the U.S. forces during the wars in Iraq and Afghanistan, which is based on chitosan, a natural biocompatible polysaccharide extracted from the shell of crustaceans.…”

mentioning

confidence: 99%

The effectiveness of a new method using an extra-alveolar hemostatic agent after dental extractions in older patients on oral anticoagulation treatment: an intrapatient study

Pippi

Santoro

Cafolla

2015

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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Dentoalveolar Procedures for the Anticoagulated Patient: Literature Recommendations Versus Current Practice

Cited by 46 publications

References 91 publications

Safety and Cost-Effectiveness of Bridge Therapies for Invasive Dental Procedures in Patients with Mechanical Heart Valves

Safety and Cost-Effectiveness of Bridge Therapies for Invasive Dental Procedures in Patients with Mechanical Heart Valves

Guideline-Discordant Periprocedural Interruptions in Warfarin Therapy

The effectiveness of a new method using an extra-alveolar hemostatic agent after dental extractions in older patients on oral anticoagulation treatment: an intrapatient study

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