Dental extractions in patients maintained on continued oral anticoagulant: Comparison of local hemostatic modalities☆,☆☆

https://doi.org/10.1016/S1079-2104(99)70106-XGet rights and content

Abstract

Objective. The purpose of this study was to evaluate postoperative bleeding in patients treated with oral anticoagulant drugs who underwent dental extractions without interruption of the treatment and to compare the effect of 3 different hemostatic modalities. Study design. A total of 150 patients who underwent dental extractions were divided into 3 groups. Local hemostasis was carried out as follows: group 1 (119 extractions), with gelatin sponge and sutures; group 2 (117 extractions), with gelatin sponge, sutures, and mouthwash with tranexamic acid; group 3 (123 extractions), with fibrin glue, gelatin sponge, and sutures. Results. Of 150 patients, 13 (8.6%) presented with postoperative bleeding: 3 patients from group 1, 6 patients from group 2, and 4 patients from group 3. Conclusions. Dental extractions can be performed without interruption in patients treated with oral anticoagulant. Local hemostasis with gelatin sponge and sutures is sufficient. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:137-40)

Section snippets

PATIENTS AND METHODS

A group of 150 patients, 85 men and 65 women ranging in age from 35 to 90 years, underwent 359 dental extractions without interruption or modification of their oral anticoagulant treatments. All patients were using coumarin; the reasons were as follows: valvular disease (70 patients), atrial fibrillation (26 patients), valvular disease and atrial fibrillation (20 patients), ischemic heart disease (29 patients), and venous thromboembolism (5 patients).

The anticoagulant activity of coumarin was

RESULTS

The results of the study are summarized in Table I.

. Patients under coumarin treatment undergoing dental extractions

Empty CellPattent group
IIIIII
Gender
 Male353318
 Female151732
Age range (y)40-8635-7940-93
No. of dental extractions
 Maxilla607084
 Mandible594739
Cause of extraction
 Periodontitis8797109
 Deep caries32208
INR mean2.382.72.19
Postoperative bleeding
 Maxilla344
 Mandible020
INR mean for cases presenting with postoperative bleeding2.892.62.3

In group 1, resorbable gelatin sponge and sutures were used for the local

DISCUSSION

In the past, some authors proposed that anticoagulant treatment be stopped 2 to 6 days before extractions, arguing that severe hemorrhage has been reported in several cases.1, 2 On the other hand, “rebound hypercoagulation” has been reported after interruption of the anticoagulant treatment for extractions19, 20, 21; accordingly, other investigators recommended stopping anticoagulant treatment and replacing it with heparin.22 Still other authors recommended the intake of anticoagulant drugs be

Acknowledgements

We thank Professor Amos Buchner for his helpful assistance and advice and Ms Rita Lazar for editorial assistance.

References (23)

  • RB Donoff

    Massachusetts General Hospital. Manual of oral and maxillofacial surgery management considerations in the medically compromised patient

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    1079-2104/99/$8.00 + 0  7/12/99134

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    Reprint requests: Danielle Blinder, MD, DMD, Department of Oral and Maxillofacial Surgery, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel

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