Dental extractions in patients taking anticoagulant therapy

Patients who are taking oral anticoagulation therapy to prevent or treat their cardiovascular diseases, are often patients in dental offices. Usually, there are incongruously treated, or sent for simple interventions or dental procedures to oral surgeon. There is a theoretical risk of bleeding after dental surgery in patients at therapeutic levels of anticoagulation, however it is minimal, and may be greatly outweighed by the risk of thromboembolism upon anticoagulant therapy withdrawal. Thus, dental extractions can be performed without modification or interruption of oral anticoagulant therapy. In most patients local hemostasis with gelatin sponge, sutures and/or mouthwash with tranexamic acid is sufficient to prevent postoperative bleeding. Sixteen patients taking oral coumarin anticoagulant therapy and undergoing dental extractions took part in this study. Three groups of patients were performed according to therapeutic prothrombin time which was declared as International Normalization Ratio(INR). Extensively postoperative bleeding was prevented with gelatine sponge (Gelatamp® ) and 4.8 % tranexamic acid mouthwash (Cyklokapron® ). Among sixteen patients with average bleeding time of 3.75 ± 1.05 minutes and INR values inside therapeutic range (<3.0), only two of them had short episodes of delayed bleeding. It was stopped by placing a suture over extraction wound. Conclusion: Anticoagulant patients who have been receiving lifelong therapy (Marivarin® ) for prevention and curing cardiovascular diseases, in consultation with the relevant specialist, and who are inside therapeutic range of prothrombin time (declared as INR), suitable thrombocyte range and bleeding time, can be accepted for tooth extraction without stopping or reducing warfarin therapy. Bleeding control was promoted locally without risk of any side effects primarily postoperative bleeding.