Risk of bleeding after dentoalveolar surgery in patients taking anticoagulants

Abstract To avoid increasing the risk of thromboembolic events, it is recommended that treatment with anticoagulants should be continued during dentoalveolar operations. We have evaluated the incidence of bleeding after dentoalveolar operations in a prospective study of 206 patients, 103 who were, a...

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Bibliographic Details
Published in:British journal of oral & maxillofacial surgery 2014-03, Vol.52 (3), p.e15-e19
Main Authors: Broekema, Ferdinand I, van Minnen, Baucke, Jansma, Johan, Bos, Rudolf R.M
Format: Article
Language:English
Subjects:
Acenocoumarol
Adult
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Antifibrinolytic Agents - therapeutic use
Apicectomy
Apicoectomy - methods
Aspirin
Dental implantation
Dental Implantation, Endosseous - methods
Dentistry
Female
Gingiva - surgery
Haemorrhage
Hemostatic Techniques
Humans
Male
Middle Aged
Oral Hemorrhage - etiology
Oral Surgical Procedures - methods
Platelet Aggregation Inhibitors - therapeutic use
Postoperative Hemorrhage - etiology
Practice Guidelines as Topic
Prospective Studies
Risk Factors
Self Care
Surgery
Tooth extraction
Tooth Extraction - methods
Tranexamic Acid - therapeutic use
Vitamin K - antagonists & inhibitors
Young Adult
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Summary:Abstract To avoid increasing the risk of thromboembolic events, it is recommended that treatment with anticoagulants should be continued during dentoalveolar operations. We have evaluated the incidence of bleeding after dentoalveolar operations in a prospective study of 206 patients, 103 who were, and 103 who were not, taking anticoagulants. Seventy-one were taking thrombocyte aggregation inhibitors and 32 vitamin K antagonists. Patients were treated according to guidelines developed at the Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. The operations studied included surgical extraction (when the surgeon had to incise the gingiva before extraction), non-surgical extraction, apicectomy, and placement of implants. Patients were given standard postoperative care and those taking vitamin K antagonists used tranexamic acid mouthwash postoperatively. No patient developed a severe bleed that required intervention. Seven patients (7%) taking anticoagulants developed mild postoperative bleeds. Patients taking vitamin K antagonists reported 3 episodes (9%) compared with 4 (6%) in the group taking thrombocyte aggregation inhibitors. Among patients not taking anticoagulants, two (2%) developed mild bleeding. The differences between the groups were not significant. All bleeding was controlled by the patients themselves with compression with gauze. We conclude that dentoalveolar surgery is safe in patients being treated with anticoagulants provided that the conditions described in the ACTA guidelines are met.
ISSN:0266-4356
1532-1940
DOI:10.1016/j.bjoms.2014.01.006