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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
Christian Bacci
1   Department of Medical and Surgical Science, Section of Clinical Dentistry, University of Padova, Padova, Italy
2   Department of Dentistry, Unit of Dentistry and Stomatology, Provincial Health Service of Trento, Trento, Italy
,
Michele Maglione
3   Department of Biomedicine, Unit of Dental Sciences and Biomaterials, University of Trieste, Trieste, Italy
,
Lorenzo Favero
1   Department of Medical and Surgical Science, Section of Clinical Dentistry, University of Padova, Padova, Italy
,
Alessandro Perini
3   Department of Biomedicine, Unit of Dental Sciences and Biomaterials, University of Trieste, Trieste, Italy
,
Roberto Di Lenarda
3   Department of Biomedicine, Unit of Dental Sciences and Biomaterials, University of Trieste, Trieste, Italy
,
Mario Berengo
1   Department of Medical and Surgical Science, Section of Clinical Dentistry, University of Padova, Padova, Italy
,
Ezio Zanon
4   Department of Cardiac, Thoracic and Vascular Science, Second Chair of Internal Medicine, University of Padova, Padova, Italy
› Author Affiliations
Further Information

Publication History

Received: 24 February 2010

Accepted after major revision: 02 July 2010

Publication Date:
24 November 2017 (online)

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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
 

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