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Medline ® Abstracts for References 29-35

of 'Perioperative management of patients receiving anticoagulants'

29
TI
Management, during dental surgery, of patients on anticoagulants.
AU
McIntyre H
SO
Lancet. 1966;2(7454):99.
 
AD
PMID
30
TI
Dental surgery in anticoagulated patients.
AU
Wahl MJ
SO
Arch Intern Med. 1998;158(15):1610.
 
Continuous oral anticoagulant therapy has been used to decrease the risk of thromboembolism for more than half a century, prolonging the lives of thousands of patients. Many physicians recommend interrupting continuous anticoagulant therapy for dental surgery to prevent hemorrhage. In reviewing the available literature, there are no well-documented cases of serious bleeding problems from dental surgery in patients receiving therapeutic levels of continuous warfarin sodium therapy, but there were several documented cases of serious embolic complications in patients whose warfarin therapy was withdrawn for dental treatment. Many authorities state that dental extractions can be performed with minimal risk in patients who are at or above therapeutic levels of anticoagulation. There are sound legal reasons to continue therapeutic levels of warfarin for dental treatment. Although there is a theoretical risk of hemorrhage after dental surgery in patients who are at therapeutic levels of anticoagulation, the risk appears to be minimal, the bleeding usually can be easily treated with local measures, and this risk may be greatly outweighed by the risk of thromboembolism after withdrawal of anticoagulant therapy.
AD
Department of Dentistry, Christiana Care Health Services, Wilmington, Del, USA.
PMID
31
TI
Dental procedures can be undertaken without alteration of oral anticoagulant regimen.
AU
Malden N
SO
Evid Based Dent. 2005;6(1):11.
 
DATA SOURCES: Medline provided the primary data source with references from identified articles being reviewed for additional studies. The Cochrane Collaboration database was also searched and a search performed of cited references.
STUDY SELECTION: Clinical studies, in English, examining perioperative management of patients receiving long-term oral anticoagulant (OAC) therapy were selected.
DATA EXTRACTION AND SYNTHESIS: Data were extracted regarding management strategy, thrombo-embolic events and bleeding complications, and type of surgical or invasive procedure. Event rates were reported as number of patients experiencing the event divided by number of patients at risk. Binomial and Poisson distributions were used to calculate 95% confidence intervals (CI).
RESULTS: A total of 31 reports were identified and concluded to be of generally poor quality. For studies reporting thrombo-embolic events, 29 events occurred in 1868 patients (1.6%; 95% CI, 1.0-2.1) of which seven were strokes (0.4%; 95% CI, 0.0-0.7). Major bleeding while receiving OAC was reported to be rare for dental procedures (occurring in four out of 2014 individuals), arthrocentesis (in none out of 32), cataract surgery (none out of 203), and upper endoscopy or colonoscopy with or without biopsy (no occurrences in 111 patients). For the other invasive and surgical procedures reviewed, OAC needs to be withheld and a suitable personalised perioperative management strategy instigated. A guideline, based on the limited evidence available, for the perioperative management of anticoagulation for procedures requiring discontinuation of OAC is presented.
CONCLUSIONS: Certain surgical or invasive procedures can be undertaken in patients who are taking OAC therapy without alteration of their regimen. For procedures requiring discontinuation of OAC, personalised management strategies are required. More rigorous studies are needed to better inform this debate.
AD
Department of Oral Surgery, University of Edinburgh, Edinburgh Dental Institute, Edinburgh, UK.
PMID
32
TI
Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding.
AU
Blinder D, Manor Y, Martinowitz U, Taicher S
SO
Int J Oral Maxillofac Surg. 2001;30(6):518.
 
The purpose of this study was to evaluate the incidence of postoperative bleeding in patients treated with oral anticoagulant medication who underwent dental extractions without interruption of the treatment and to analyze the incidence of postoperative bleeding according to the International Normalized Ratio (INR) value. The 249 patients who underwent 543 dental extractions were divided into five groups: Group 1 with INRs of 1.5-1.99, Group 2 with INRs of 2-2.49, Group 3 with INRs of 2.5-2.99, Group 4 with INRs of 3-3.49 and Group 5 with INRs>3.5. The INR was measured on the day of the procedure. Local haemostasis was carried out with gelatin sponge and multiple silk sutures. Of the 249 patients, 30 presented with postoperative bleeding (12%): Group 1, three patients presented with bleeding (5%), Group 2, 10 patients (12.8%), Group 3, nine patients (15.2%), Group 4, five patients (16.6%) and Group 5, three patients (13%). The incidence of postoperative bleeding was not significantly different among the five groups. The value of the INR at the therapeutic dose did not significantly influence the incidence of postoperative bleeding. Thus, dental extractions can be performed without modification of oral anticoagulant treatment. Local haemostasis with gelatin sponge and sutures appears to be sufficient to prevent postoperative bleeding.
AD
Department of Oral and Maxillofacial Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel. aleshkov@netvision.net.il
PMID
33
TI
[Protocol for adapting treatment with vitamin K antagonists before dental extraction].
AU
Garcia-Darennes F, Darennes J, Freidel M, Breton P
SO
Rev Stomatol Chir Maxillofac. 2003;104(2):69.
 
BACKGROUND: The purpose of this study was to validate a protocol for dental extraction in patients taking vitamin K antagonists without changing the treatment when the INR is lower than 2.8.
MATERIAL AND METHODS: One hundred four extractions (96 patients) were performed during a 9 month period in patients taking vitamin K antagonists. Extraction was performed when the international normalized ratio (INR) was less than 2.8, otherwise, the treatment was modified until the desired INR was reached. Extractions were performed under para-apical and alveolar local anesthesia and sutured with hemostatic gauze.
RESULTS: Three patients developed postoperative bleeding requiring alveolar revision with local application of tranexamic acid and in one case use of a biological glue.
DISCUSSION: The following protocol can be proposed: ambulatory extraction under local anesthesia with an INR the day before extraction: the extraction is performed if the INR is<=2.8 using hemostatic gauze suture and tranexamic acid in case of persistent bleeding.
AD
Service de Stomatologie de l'Hôpital Cardiovasculaire et Pneumologique Louis Pradel, 28, rue du Doyen Lépine, 69500 Bron.
PMID
34
TI
Guidelines for the management of patients on oral anticoagulants requiring dental surgery.
AU
Perry DJ, Noakes TJ, Helliwell PS, British Dental Society
SO
Br Dent J. 2007;203(7):389.
 
The objective of these guidelines is to provide healthcare professionals, including primary care dental practitioners, with clear guidance on the management of patients on oral anticoagulants requiring dental surgery. The guidance may not be appropriate in all cases and individual patient circumstances may dictate an alternative approach.
AD
British Committee for Standards in Haematology and Department of Haematology, Box 234, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ. david.perry@addenbrookes.nhs.uk
PMID
35
TI
Treatment with local hemostatic agents and primary closure after tooth extraction in warfarin treated patients.
AU
Svensson R, Hallmer F, Englesson CS, Svensson PJ, Becktor JP
SO
Swed Dent J. 2013;37(2):71.
 
UNLABELLED: The aim of this retrospective study was to assess the frequency of postoperative bleeding in patients on warfarin after tooth removal followed by a complete soft tissue closure of the surgical site. A total of 124 consecutive patients, 69 males and 55 females with a mean age of 71 years (range 28-95 years) were included in this study. Inclusion criteria were patients on warfarin with an INR<or=3.5 who were referred for tooth removal (single or multiple) during 2004-2009. After tooth extraction all sockets were packed with an absorbable haemostatic gelatin sponge or a collagen fleece and subsequently the sockets was primary closed with sutures. 5/124 (4%) patients returned with postoperative bleedings. All patients with a postoperative bleeding had received a surgical extraction in the posterior part of the maxilla. Consequently no patient had a postoperative bleeding in the mandible. None of the 124 patients returned to the clinic with a dry socket or postoperative pain. 3/124 (2%) patients returned with postoperative infection that required antibiotic treatment. All patients who bled were managed conservatively and none was admitted to hospital.
CONCLUSION: According to the protocol of this study (local hemostatic, primary closure, sutures and tranexamic acid) the risk of postoperative bleeding after tooth removal in patients on continued warfarin medication is low.
AD
Department of Oral Surgery and Oral Medicine Faculty of Odontology, MalmöUniversity, Malmo, Sweden.
PMID