Management of dental extraction in patients undergoing anticoagulant treatment

Christian Bacci; Michele Maglione; Lorenzo Favero; Alessandro Perini; Roberto Di Lenarda; Mario Berengo; Ezio Zanon

doi:10.1160/TH10-02-0139

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 104(05): 972-975
DOI: 10.1160/TH10-02-0139

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Management of dental extraction in patients undergoing anticoagulant treatment

Results from a large, multicentre, prospective, case-control study

Authors

Christian Bacci

¹Department of Medical and Surgical Science, Section of Clinical Dentistry, University of Padova, Padova, Italy

²Department of Dentistry, Unit of Dentistry and Stomatology, Provincial Health Service of Trento, Trento, Italy
Michele Maglione

³Department of Biomedicine, Unit of Dental Sciences and Biomaterials, University of Trieste, Trieste, Italy
Lorenzo Favero

¹Department of Medical and Surgical Science, Section of Clinical Dentistry, University of Padova, Padova, Italy
Alessandro Perini

³Department of Biomedicine, Unit of Dental Sciences and Biomaterials, University of Trieste, Trieste, Italy
Roberto Di Lenarda

³Department of Biomedicine, Unit of Dental Sciences and Biomaterials, University of Trieste, Trieste, Italy
Mario Berengo

¹Department of Medical and Surgical Science, Section of Clinical Dentistry, University of Padova, Padova, Italy
Ezio Zanon

⁴Department of Cardiac, Thoracic and Vascular Science, Second Chair of Internal Medicine, University of Padova, Padova, Italy

Abstract

Summary

Following favourable results from a previous study, a large, multicentre, prospective, case-control study was performed to further assess the incidence of bleeding complications after dental extraction in patients taking oral anticoagulant therapy (OAT). Four hundred fifty-one patients being treated with warfarin who required dental extraction were compared with a control group of 449 non-anticoagulated subjects undergoing the same procedure. In the warfarin-treated group, the oral anticoagulant regimen was maintained unchanged, such that the patients had an International Normalised Ratio ranging between 1.8 and 4, and local haemostatic measures (i.e. fibrin sponges, silk sutures and gauzes saturated with tranexamic acid) were adopted. All the procedures were performed in an outpatient setting. Seven bleeding complications occurred in the OAT group and four in the control group; the difference in the number of bleeding events between the two groups was not statistically significant (OR=1.754; 95% CI 0.510 – 6.034; p=0.3727). No post-operative late bleeds requiring hospitalisation and/or blood transfusions were recorded, and the adjunctive local haemostatic measures were adequate to stop the bleeding. The results of our protocol applied in this large, multicenter study show that dental extractions can be performed easily and safely in anticoagulated out-patients without any modification of the ongoing anticoagulant therapy, thus minimising costs and reducing discomfort for patients.

Keywords

Dental extraction - anticoagulated patients - warfarin therapy - multi-center study

Full Text

References

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