Stomatological management of anticoagulated patients undergoing oral surgery: a narrative review. [English translation-Original in Spanish]

Autores/as

  • Javiera Cancino Universidad Finis Terrae
  • Diego Fonseca Universidad Andrés Bello
  • Fernando Parada Universidad Andrés Bello

DOI:

https://doi.org/10.59334/ROV.v2i39.590

Palabras clave:

dental care, anticoagulants, Oral surgery, Oral hemorrage

Resumen

Patients undertaking oral anticoagulant treatment may experience alterations in different stages of hemostasis, which lead to medical/surgical implications and considerations during their care. Currently, there is no consensus regarding the dental management of these patients, as they go through surgical procedures.

This leads to clinical protocols that follow numerous approaches, such as reducing the pharmacological intake of the anticoagulant, replacing it with heparin, and maintaining the controlled treatment.

Objective: To establish the stomatological management of the patient undergoing oral anticoagulant treatment through an in-depth review of the literature.

Materials and Method: A manual bibliographic review search of articles indexed to the PUBMED and EBSCO databases corresponding to the words “oral surgery”, “oral bleeding”, “anticoagulants” and “dental management” was performed. Regarding the inclusion criteria: bibliographic reviews, observational studies, clinical trials, guidelines, systematic reviews, and meta-analyses published between November 2005 and 2022, in English or Spanish, were considered.

Conclusion: There are multiple protocols for the care of the anticoagulated patient who will undergo a minor oral surgery procedure. It is important to reflect on the anticoagulant used, the reason for it, its supervision, the surgical procedure that will be undertaken by the patient, and both intraoperative and postoperative hemostatic measures to be implemented.

After analyzing the above, it is noted that reducing the intake of the drug to perform the surgical procedure may be harmful to the patient and to the clinician, therefore it is suggested to maintain the antithrombotic treatment and carry out a correct medical/surgical management.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

Adcock, D. M., & Gosselin, R. (2015). Direct Oral Anticoagulants (DOACs) in the Laboratory: 2015 Review. Thrombosis Research, 136(1), 7-12. https://doi.org/10.1016/j.thromres.2015.05.001.

Andras, A., Sala Tenna, A., & Stewart, M. (2017). Vitamin K antagonists versus low-molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism. Cochrane Database Syst Rev, 7(7), Cd002001. https://doi.org/10.1002/14651858.CD002001.pub3.

Babin, J. L., Traylor, K. L., & Witt, D. M. (2017). Laboratory Monitoring of Low-Molecular-Weight Heparin and Fondaparinux. Semin Thromb Hemost, 43(3), 261-269. https://doi.org/10.1055/s-0036-1581129.

Bajkin, B. V., Selaković, S. D., Mirković, S. M., Šarčev, I. N., Tadič, A. J., & Milekič, B. R. (2014). Comparison of efficacy of local hemostatic modalities in anticoagulated patients undergoing tooth extractions. Vojnosanit Pregl, 71(12), 1097-1101. https://doi.org/10.2298/vsp1412097b.

Beurskens, D. M. H., Huckriede, J. P., Schrijver, R., Hemker, H. C., Reutelingsperger, C. P., & Nicolaes, G. A. F. (2020). The Anticoagulant and Nonanticoagulant Properties of Heparin. Thromb Haemost, 120(10), 1371-1383. https://doi.org/10.1055/s-0040-1715460.

Blann, A. D., & Lip, G. Y. (2014). Laboratory monitoring of the non-vitamin K oral anticoagulants. J Am Coll Cardiol, 64(11), 1140-1142. https://doi.org/10.1016/j.jacc.2014.07.010.

Calcia, T. B. B. B., Oballe, H. J. R., de Oliveira Silva, A. M., Friedrich, S. A., & Muniz, F. (2021). Is alteration in single drug anticoagulant/antiplatelet regimen necessary in patients who need minor oral surgery? A systematic review with meta-analysis. Clin Oral Investig, 25(6), 3369-3381. https://doi.org/10.1007/s00784-021-03882-z.

Caliskan, M., Tükel, H. C., Benlidayi, M. E., & Deniz, A. (2017). Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants? Med Oral Patol Oral Cir Bucal, 22(6), e767-e773. https://doi.org/10.4317/medoral.21942

Conway, S. E., Hwang, A. Y., Ponte, C. D., & Gums, J. G. (2017). Laboratory and Clinical Monitoring of Direct Acting Oral Anticoagulants: What Clinicians Need to Know. Pharmacotherapy, 37(2), 236-248. https://doi.org/10.1002/phar.1884.

Costa-Tort, J., Schiavo-Di Flaviano, V., González-Navarro, B., Jané-Salas, E., Estrugo-Devesa, A., & López-López, J. (2021). Update on the management of anticoagulated and antiaggregated patients in dental practice: Literature review. Journal of Clinical and Experimental Dentistry, 13(9), e948-e956. https://doi.org/10.4317/jced.58586.

Crader, M. F., Johns, T., & Arnold, J. K. (2022). Warfarin Drug Interactions. In StatPearls. StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.

Da Silva, R. V., Gadelha, T. B., Luiz, R. R., & Torres, S. R. (2018). Intra-alveolar epsilon-aminocaproic acid for the control of post-extraction bleeding in anticoagulated patients: randomized clinical trial. International Journal of Oral and Maxillofacial Surgery, 47(9), 1138-1144. https://doi.org/10.1016/j.ijom.2018.02.013.

de Vasconcellos, S. J., de Santana Santos, T., Reinheimer, D. M., Faria, E. S. A. L., de Melo, M. F., & Martins-Filho, P. R. (2017). Topical application of tranexamic acid in anticoagulated patients undergoing minor oral surgery: A systematic review and meta-analysis of randomized clinical trials. J Craniomaxillofac Surg, 45(1), 20-26.https://doi.org/10.1016/j.jcms.2016.10.001.

Despas, N., Larock, A. S., Jacqmin, H., Douxfils, J., Chatelain, B., Chatelain, M., & Mullier, F. (2016). Heparin monitoring: clinical outcome and practical approach. Ann Biol Clin (Paris), 74(6), 637-652. https://doi.org/10.1684/abc.2016.1198 (Suivi biologique de l’héparinothérapie : intérêt clinique et aspects pratiques.).

Di Carlo, A., Bellino, L., Consoli, D., Mori, F., Zaninelli, A., Baldereschi, M., Cattarinussi, A., D’Alfonso, M. G., Gradia, C., Sgherzi, B., Pracucci, G., Piccardi, B., Polizzi, B., & Inzitari, D. (2019). Prevalence of atrial fibrillation in the Italian elderly population and projections from 2020 to 2060 for Italy and the European Union: the FAI Project. Europace, 21(10), 1468-1475. https://doi.org/10.1093/europace/euz141.

Di Minno, A., Frigerio, B., Spadarella, G., Ravani, A., Sansaro, D., Amato, M., Kitzmiller, J. P., Pepi, M., Tremoli, E., & Baldassarre, D. (2017). Old and new oral anticoagulants: Food, herbal medicines and drug interactions. Blood Reviews, 31(4), 193-203. https://doi.org/10.1016/j.blre.2017.02.001

Engelen, E. T., Schutgens, R. E. G., Mauser-Bunschoten, E. P., van Es, R. J. J., & van Galen, K. P. M. (2018). Antifibrinolytic therapy for preventing oral bleeding in people on anticoagulants undergoing minor oral surgery or dental extractions. Cochrane Database of Systematic Reviews(7). https://doi.org/10.1002/14651858.CD012293.pub2

Expósito, M. C. (2010). Treatment with oral anticoagulants: initiation, adjustment and precautions in their use. Advances in Diabetology, 26(1), 17-20. https://doi.org/10.1016/S1134-3230(10)61004-6

Gale, A. J. (2011). Continuing education course #2: current understanding of hemostasis. Toxicol Pathol, 39(1), 273-280. https://doi.org/10.1177/0192623310389474

Gazit, Y., Jacob, G., & Grahame, R. (2016). Ehlers-Danlos Syndrome-Hypermobility Type: A Much Neglected Multisystemic Disorder. Rambam Maimonides Med J, 7(4). https://doi.org/10.5041/RMMJ.10261

Gomez, K., Anderson, J., Baker, P., Biss, T., Jennings, I., Lowe, G., & Platton, S. (2021). Clinical and laboratory diagnosis of heritable platelet disorders in adults and children: a British Society for Haematology Guideline. Br J Haematol, 195(1), 46-72. https://doi.org/10.1111/bjh.17690

González Guerrero, C., & Montoro Ronsano, J. B. (2015). Physiopathology and treatment of critical bleeding: a literature review. Farmacia Hospitalaria, 39, 382-398. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-63432015000600008&nrm=iso

Grymonprez, M., Simoens, C., Steurbaut, S., De Backer, T. L., & Lahousse, L. (2022). Worldwide trends in oral anticoagulant use in patients with atrial fibrillation from 2010 to 2018: a systematic review and meta-analysis. Europace, 24(6), 887-898. https://doi.org/10.1093/europace/euab303.

Guerrero, B., & López, M. (2015). Generalities of the coagulation system and tests for its study. Investigación Clínica, 56, 432-454. http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S053551332015000400010&nrm=iso

Harenberg, J. (2011a). Differences of present recommendations and guidelines for generic low-molecular-weight heparins: is there room for harmonization? Clin Appl Thromb Hemost, 17(6), E158-164. https://doi. org/10.1177/1076029610392216.

Harenberg, J. (2011b). Overview on guidelines and recommendations for generic low-molecular-weight heparins. Thromb Res, 127 Suppl 3, S100-104. https://doi.org/10.1016/s0049-3848(11)70027-5

Hatton, C. S. R., Hughes-Jones, N. C., & Hay, D. (2013). Hematology: diagnosis and treatment. Editorial El Manual Moderno. https://books.google.cl/books?id=xH7-CAAAQBAJ

Heparin (2006). In Drugs and Lactation Database (LactMed®). National Institute of Child Health and Human Development.

Huang, J., Liu, J., Shi, H., Wu, J., Liu, J., & Pan, J. (2022). Risk factors for bleeding after dental extractions in patients receiving antithrombotic drugs - A case control study. Journal of Dental Sciences, 17(2), 780-786. https://doi.org/10.1016/j.jds.2021.10.005

Inokoshi, M., Kubota, K., Yamaga, E., Ueda, K., & Minakuchi, S. (2021). Postoperative bleeding after dental extraction among elderly patients under anticoagulant therapy. Clinical Oral Investigations, 25(4), 2363-2371. https://doi.org/10.1007/s00784-020-03559-z.

Iwabuchi, H., Imai, Y., Asanami, S., Shirakawa, M., Yamane, G.-y., Ogiuchi, H., Kurashina, K., Miyata, M., Nakao, H., & Imai, H. (2014). Evaluation of postextraction bleeding incidence to compare patients receiving and not receiving warfarin therapy: a cross-sectional, multicentre, observational study. BMJ Open, 4(12), e005777. https://doi.org/10.1136/bmjopen-2014-005777.

Kent, A. P., Brueckmann, M., Fraessdorf, M., Connolly, S. J., Yusuf, S., Eikelboom, J. W., Oldgren, J., Reilly, P. A., Wallentin, L., & Ezekowitz, M. D. (2018). Concomitant Oral Anticoagulant and Nonsteroidal Anti-Inflammatory Drug Therapy in Patients With Atrial Fibrillation. J Am Coll Cardiol, 72(3), 255-267. https://doi.org/10.1016/j.jacc.2018.04.063.

Kornej, J., Börschel, C. S., Benjamin, E. J., & Schnabel, R. B. (2020). Epidemiology of Atrial Fibrillation in the 21st Century. Circulation Research, 127(1), 4-20. https://doi.org/10.1161/CIRCRESAHA.120.316340

Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran. Structural and functional pathology. Elsevier Health Sciences Spain. https://books.google.cl/books?id=fOJiCAAAQBAJ

LaPelusa, A., & Dave, H. D. (2022). Physiology, Hemostasis. In StatPearls. StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.

Little, J. W., Miller, C., Miller, C. S., & Rhodus, N. L. (2017). Little and Falace’s Dental Management of the Medically Compromised Patient. Elsevier - Health Sciences Division. https://books.google.cl/books?id=8pRAQAACAAJ.

Manfredini, M., Poli, P. P., Creminelli, L., Porro, A., Maiorana, C., & Beretta, M. (2021). Comparative Risk of Bleeding of Anticoagulant Therapy with Vitamin K Antagonists (VKAs) and with Non-Vitamin K Antagonists in Patients Undergoing Dental Surgery. Journal of Clinical Medicine, 10(23), 5526. https://doi.org/10.3390/jcm10235526

Nazar J., C., Cárdenas C., A., Coloma D., R., Contreras C., J. I., Molina, I., Miranda H., P., & Fuentes H., R. (2018). Perioperative management of patients with chronic anticoagulant therapy. Revista chilena de cirugía, 70, 84-91. http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0718-40262018000100084&nrm=iso.

Onishi, A., St Ange, K., Dordick, J. S., & Linhardt, R. J. (2016). Heparin and anticoagulation. Front Biosci (Landmark Ed), 21(7), 1372-1392. https://doi.org/10.2741/4462

Patel, S., Singh, R., Preuss, C. V., & Patel, N. (2022). Warfarin. In StatPearls. StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.

Polania Gutierrez JJ, Rocuts KR. Perioperative Anticoagulation Management. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023. PMID: 32491522.

Rocha, A. L., Oliveira, S. R., Souza, A. F., Travassos, D. V., Abreu, L. G., Ribeiro, D. D., & Silva, T. A. (2019). Bleeding assessment in oral surgery: A cohort study comparing individuals on anticoagulant therapy and a non-anticoagulated group. Journal of Cranio-Maxillofacial Surgery, 47(5), 798-804. https://doi.org/10.1016/j.jcms.2019.01.049

Smith, S. A., Travers, R. J., & Morrissey, J. H. (2015). How it all starts: initiation of the clotting cascade. Crit Rev Biochem Mol Biol, 50(4), 326-336. https://doi.org/10.3109/10409238.2015.1050550

Ufer, M. (2005). Comparative pharmacokinetics of vitamin K antagonists: warfarin, phenprocoumon and acenocoumarol. Clin Pharmacokinet, 44(12), 1227-1246. https://doi.org/10.2165/00003088-200544120-00003.

Walenga, J. M., Jackson, C. M., & Kessler, C. M. (2011). Low molecular weight heparins differ substantially: impact on developing biosimilar drugs. Semin Thromb Hemost, 37(3), 322-327. https://doi.org/10.1055/s-0031-1274515.

Wilson, W. R., Gewitz, M., Lockhart, P. B., Bolger, A. F., DeSimone, D. C., Kazi, D. S., Couper, D. J., Beaton, A., Kilmartin, C., Miro, J. M., Sable, C., Jackson, M. A., & Baddour, L. M. (2021). Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation, 143(20), e963-e978. https://doi.org/10.1161/cir.0000000000000969.

Winter, W. E., Flax, S. D., & Harris, N. S. (2017). Coagulation Testing in the Core Laboratory. Laboratory Medicine, 48(4), 295-313. https://doi.org/10.1093/labmed/lmx050

Woolcombe, S. A., Ball, R. E., & Patel, J. P. (2022). Managing direct oral anticoagulants in accordance with the Scottish Dental Clinical Effectiveness Programme guidance for patients undergoing dentoalveolar surgery. British Dental Journal, 232(8), 547-554. https://doi.org/10.1038/s41415-022-3999-y.

Yamada, S.-i., Hasegawa, T., Soutome, S., Yoshimura, H., Miyakoshi, M., Ueda, N., Okamoto, K., Hishida, S., Rokutanda, S., Nakahara, H., Fujita, S., Akashi, M., Kitagawa, Y., Kirita, T., Shibuya, Y., Umeda, M., & Kurita, H. (2020). Prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction on warfarin therapy: a multicenter retrospective study in Japan. Dentistry, 108(3), 462-469. https://doi.org/10.1007/s10266-019-00474-y.

Portada del artículo

Publicado

2023-07-31

Cómo citar

Cancino, J., Fonseca, D., & Parada, F. (2023). Stomatological management of anticoagulated patients undergoing oral surgery: a narrative review. [English translation-Original in Spanish]. O.V., 2(39), 76–92. https://doi.org/10.59334/ROV.v2i39.590

Número

Sección

Revisión

Categorías

Métricas alternativas