Stomatological management of anticoagulated patients undergoing oral surgery: a narrativ
DOI:
https://doi.org/10.59334/ROV.v2i39.590Keywords:
dental care, anticoagulants, Oral surgery, Oral hemorrageAbstract
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.
Downloads
References
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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: https://doi.org/10.1016/j.jacc.2014.07.010
Calcia, T. 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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.) DOI: https://doi.org/10.1684/abc.2016.1198
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 DOI: 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/https://doi.org/10.1016/j.blre.2017.02.001 DOI: 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 DOI: https://doi.org/10.1002/14651858.CD012293.pub2
Expósito, M. C. (2010). Tratamiento con anticoagulantes orales: inicio, ajuste y precauciones en su utilización. Avances en Diabetología, 26(1), 17-20. https://doi.org/https://doi.org/10.1016/S1134-3230(10)61004-6 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: https://doi.org/10.1093/europace/euab303
Guerrero, B., & López, M. (2015). Generalidades del sistema de la coagulación y pruebas para su estudio. Investigación Clínica, 56, 432-454. http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0535-51332015000400010&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 DOI: 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 DOI: https://doi.org/10.1016/S0049-3848(11)70027-5
Hatton, C. S. R., Hughes-Jones, N. C., & Hay, D. (2013). Hematología: Diagnóstico y tratamiento. 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/https://doi.org/10.1016/j.jds.2021.10.005 DOI: 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 DOI: 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 DOI: 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 DOI: 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/doi:10.1161/CIRCRESAHA.120.316340 DOI: https://doi.org/10.1161/CIRCRESAHA.120.316340
Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins y Cotran. Patología estructural y funcional. 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=8p-RAQAACAAJ
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 DOI: 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). Manejo perioperatorio de pacientes con tratamiento anticoagulante crónico. Revista chilena de cirugía, 70, 84-91. https://doi.org/10.1016/j.rchic.2017.06.003 DOI: https://doi.org/10.1016/j.rchic.2017.06.003
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 DOI: 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, J. J., & Rocuts, K. R. (2022). Perioperative Anticoagulation Management. StatPearls Publishing, Treasure Island (FL). http://europepmc.org/abstract/MED/32491522 http://europepmc.org/books/NBK557590 https://www.ncbi.nlm.nih.gov/books/NBK557590
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/https://doi.org/10.1016/j.jcms.2019.01.049 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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. Odontology, 108(3), 462-469. https://doi.org/10.1007/s10266-019-00474-y DOI: https://doi.org/10.1007/s10266-019-00474-y
![Portada del artículo](https://revistas.ulatina.ac.cr/public/journals/2/submission_590_742_coverImage_es_ES.png)
Published
How to Cite
License
Copyright (c) 2023 Javiera Cancino, Diego Fonseca, Fernando Parada
![Creative Commons License](http://i.creativecommons.org/l/by-nc-sa/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with Odontología Vital agree to the following terms:
- Authors retain the copyright and grant Universidad Latina de Costa Rica the right of first publication, with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license (CC BY-NC-SA 4.0) that allows third parties to copy and redistribute the work in any medium or format, remix, transform, and built upon the work unless it is given appropriate credit, providing a link to the lincese, not using the work for commercial purposes and if the work is remixed, transformed, or built upon, it must be distributed under the same license as the original work.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the Odontología Vital's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Métricas alternativas