Journal of Oral and Maxillofacial Surgery
Volume 65, Issue 8 , Pages 1454-1460 , August 2007

Dentoalveolar Procedures for the Anticoagulated Patient: Literature Recommendations Versus Current Practice

  • Brent B. Ward, DDS, MD

      Affiliations

    • Assistant Professor and Program Director, Department of Surgery, Section of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
    • Corresponding Author InformationAddress correspondence and reprint requests to Dr Ward: University Hospital, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0018
    • ,
  • Miller H. Smith, DDS

      Affiliations

    • Resident, Department of Surgery, Section of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.

References 

  1. Young KM. Laboratory medicine: The history of warfarin. Vet Clin Path. 2005;34:76
  2. Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med. 1998;158:1610
  3. Wahl MJ. Myths of dental surgery in patients receiving anticoagulant therapy. J Am Dent Assoc. 2000;131:77
  4. Carter G, Goss AN, Lloyd J, et al. Current concepts of the management of dental extractions for patients taking warfarin. Aust Dent J. 2003;48:89
  5. Jeske AH, Suchko GD. Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment. J Am Dent Assoc. 2003;134:1492
  6. Herman WW, Konzelman JL, Sutley SH. Current perspectives on dental patients receiving coumarin anticoagulant therapy. J Am Dent Assoc. 1997;128:327
  7. Dios PD, Feijoo JF. Tooth removal and anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:248
  8. Ziffer AM, Scopp IW, Beck J, et al. Profound bleeding after dental extractions during dicumarol therapy. N Engl J Med. 1957;256:351
  9. Scopp IW, Fredrics H. Dental extractions in patients undergoing anticoagulant therapy. Oral Surg Oral Med Oral Pathol. 1958;11:470
  10. Tulloch J, Wright IS. Long-term anticoagulant therapy: further experiences. Circulation. 1954;9:823
  11. Mulligan R, Weitzel KG. Pretreatment management of the patient receiving anticoagulant drugs. J Am Dent Assoc. 1988;117:479
  12. Mulligan R. Response to anticoagulant drug withdrawal. J Am Dent Assoc. 1987;115:435
  13. Marietta M, Bertesi M, Simoni L, et al. A simple and safe nomogram for the management of oral anticoagulation prior to minor surgery. Clin Lab Haematol. 2003;25:127
  14. Todd DW. Anticoagulated patients and oral surgery. Arch Intern Med. 2003;163:1242
  15. Todd DW. Anticoagulant therapy: consideration of modification in conjunction with minor surgery. J Oral Maxillofac Surg. 2003;61:1117
  16. Lloyd RE. Dental surgery in the anticoagulated patient. Br Dent J. 2003;194:530
  17. Milligan PE, Banet GA, Gage BF. Perioperative reduction of the warfarin dose. Am J Med. 2003;115:741
  18. Davis FB, Sczupak CA. Outpatient oral anticoagulation: guidelines for long-term management. Postgrad Med. 1979;66:100
  19. Akbarian M, Austen G, Yurchak PM, et al. Thromboembolic complications of prosthetic cardiac valves. Circulation. 1968;37:826
  20. Behrman SJ, Wright IS. Dental surgery during continuous anticoagulant therapy. J Am Dent Assoc. 1961;62:172
  21. Marshall J. Rebound phenomena after anticoagulant therapy in cerebrovascular disease. Circulation. 1963;28:329
  22. Roser SM, Rosenbloom B. Continued anticoagulation in oral surgery procedures. Oral Surg Oral Med Oral Pathol. 1975;40:448
  23. Ansell JE. The perioperative management of warfarin therapy. Arch Intern Med. 2003;163:881
  24. Douketis JD. Perioperative anticoagulation management in patients who are receiving oral anticoagulant therapy: A practical guide for clinicians. Thromb Res. 2002;108:3
  25. Bailey BM, Fordyce AM. Complications of dental extractions in patients receiving warfarin anticoagulant therapy (A controlled clinical trial). Br Dent J. 1983;155:308
  26. Benoliel R, Leviner E, Katz J, et al. Dental treatment for the patient on anticoagulant therapy: Prothrombin time value–What difference does it make?. Oral Surg Oral Med Oral Pathol. 1986;62:149
  27. Greenberg MS, Miller MF, Lynch MA. Partial thromboplastin time as a predictor of blood loss in oral surgery patients receiving coumarin anticoagulants. J Am Dent Assoc. 1972;84:583
  28. Kovacs B, Toth K, Kerenyi G. Post-extraction hemostasis during coumarin anticoagulant therapy with a locally applied coagulation-active substance. Int J Oral Surg. 1976;5:3
  29. Kwapis BW. Anticoagulant therapy and dental practice. J Am Dent Assoc. 1963;66:172
  30. Shira RB, Hall RJ, Guernsey LH. Minor oral surgery during prolonged anticoagulant therapy. J Oral Surg Anesth Hosp Dent Serv. 1962;20:93
  31. Tomasi NJ, Wolf JE. Presurgical management of a patient receiving anticoagulant therapy: Report of case. J Am Dent Assoc. 1974;88:1028
  32. Waldrep AC, McKelvey LE. Oral surgery for patients on anticoagulant therapy. J Oral Surg. 1968;26:374
  33. Yoshimura Y, Oka M, Kishimoto H, et al. Hemodynamic changes during dental extraction and post-extraction bleeding in patients with prosthetic heart valves. Int J Oral Maxillofac Surg. 1987;16:425
  34. Mehta DK. Dental surgery in the anticoagulated patient. Br Dent J. 2003;194:530
  35. Malden NJ. Warfarin and extractions. Br Dent J. 2003;194:65
  36. Gibbons AJ, Evans IL, Sayers MS, et al. Warfarin and extractions. Br Dent J. 2002;193:302
  37. Gibbons AJ, Sugar AW. Evidence for continuing warfarin during dental extractions. Br Dent J. 2003;194:65
  38. Balderston RH. Warfarin and extraction. Br Dent J. 2003;194:408
  39. Brown AE. Warfarin and extractions. Br Dent J. 2002;193:668
  40. Gibbons AJ, Sugar AW. Re: Sugar AW et al: Can warfarin be continued during dental extraction? Results of a randomised controlled trial. Br J Oral Maxillofac Surg. 2003;41:280
  41. Dunn AS, Turpie AG. Perioperative management of patients receiving oral anticoagulants: A systematic review. Arch Intern Med. 2003;163:901
  42. Gibbons AJ, Sugar AW. Oral anticoagulation and dental extractions. Br J Haematol. 2002;119:1137
  43. Troulis MJ, Head TW, Leclerc JR. Dental extractions in patients on an oral anticoagulant: A survey of practices in North America. J Oral Maxillofac Surg. 1998;56:914
  44. Gohlke-Barwolf C. Anticoagulation in valvar heart disease: New aspects and management during non-cardiac surgery. Heart. 2000;84:567
  45. Ansell J, Hirsh J, Dalen J, et al. Managing oral anticoagulant therapy. Chest. 2001;119(suppl 1):22S
  46. Muthukrishnan A, Bishop K. An assessment of the management of patients on warfarin by general dental practitioners in South West Wales. Br Dent J. 2003;195:567
  47. Webster K, Wilde J. Management of anticoagulation in patients with prosthetic heart valves undergoing oral and maxillofacial operations. Br J Oral Maxillofac Surg. 2000;38:124
  48. Hirsh J, Fuster V, Ansell J, et al. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. Circulation. 2003;107:1692
  49. Fuster V, Ryden LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: Executive summary (A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the North American Society of Pacing and Electrophysiology). J Am Coll Cardiol. 2001;38:1231
  50. Lung B, Gohlke-Barwolf C, Tornos P, et al. Recommendations on the management of the asymptomatic patient with valvular heart disease. Eur Heart J. 2002;23:1252
  51. Butchart EG, Gohlke-Barwolf C, Antunes MJ, et al. Recommendations for the management of patients after heart valve surgery. Eur Heart J. 2005;26:2463
  52. Levy S, Breithardt G, Campbell RW, et al. Working Group on Arrhythmias of the European Society of Cardiology Atrial fibrillation: Current knowledge and recommendations for management. Eur Heart J. 1998;19:1294
  53. Guidelines on oral anticoagulation: Third edition. Br J Haematol. 1998;101:374
  54. Update. Guidelines on oral anticoagulation: Third edition. Paper presented at the British Society for Hematology, 2005. http://www.bcshguidelines.com
  55. Beirne OR, Koehler JR. Surgical management of patients on warfarin sodium. J Oral Maxillofac Surg. 1996;54:1115
  56. Attermann J, Andersen NT, Korsgaard H, et al. Precision of INR measured with a patient operated whole blood coagulometer. Thromb Res. 2003;110:65
  57. Fuller JL, Weinert SE. In: Evaluation of the Accuracy and Precision of the CoaguChek S Monitor. Indianapolis, IN: Roche Diagnostics Corporation; 2001;p. 1–4
  58. Gardiner C, Williams K, Mackie IJ, et al. Patient self-testing is a reliable and acceptable alternative to laboratory INR monitoring. Br J Haematol. 2004;128:242
  59. Lizotte A, Quessy I, Vanier MC, et al. Reliability, validity and ease of use of a portable point-of-care coagulation device in a pharmacist-managed anticoagulation clinic. J Thromb Thrombolysis. 2002;14:247
  60. McBane RD, Felty CL, Hartgers ML, et al. Importance of device evaluation for point-of-care prothrombin time international normalized ratio testing programs. Mayo Clin Proc. 2005;80:181
  61. Tay MH, Tien SL, Chua TS, et al. An evaluation of point-of-care instrument for monitoring anticoagulation level in adult cardiac patients. Singapore Med J. 2002;43:557
  62. Havrda DE, Hawk TL, Marvin CM. Accuracy and precision of the CoaguChek S versus laboratory INRs in a clinic. Ann Pharmacother. 2002;36:769
  63. Matthew IR, Browne RM, Frame JW, et al. Tissue response to a haemostatic alginate wound dressing in tooth extraction sockets. Br J Oral Maxillofac Surg. 1993;31:165
  64. Mattsson T, Anneroth G, Kondell PA, et al. ACP and surgical in bone hemostasis (A comparative experimental and histologic study). Swed Dent J. 1990;14:57
  65. Martinowitz U, Mazar AL, Taicher S, et al. Dental extraction for patients on oral anticoagulant therapy. Oral Surg Oral Med Oral Pathol. 1990;70:274
  66. Sheller B, Tong D. Dental management of a child on anticoagulant therapy and the International Normalized Ratio: Case report. Pediatr Dent. 1994;16:56
  67. Carr MM, Mason RB. Dental management of anticoagulated patients. J Can Dent Assoc. 1992;58:838
  68. Muthukrishnan A. Re: Webster K, Wilde J (Management of anticoagulation in patients with prosthetic heart valves undergoing oral and maxillofacial operations). Br J Oral Maxillofac Surg. 2002;40:266
  69. Al-Belasy FA, Amer MZ. Hemostatic effect of n-butyl-2-cyanoacrylate (histoacryl) glue in warfarin-treated patients undergoing oral surgery. J Oral Maxillofac Surg. 2003;61:1405
  70. Borea G, Montebugnoli L, Capuzzi P, et al. Tranexamic acid as a mouthwash in anticoagulant-treated patients undergoing oral surgery (An alternative method to discontinuing anticoagulant therapy). Oral Surg Oral Med Oral Pathol. 1993;75:29
  71. Carter G, Goss A. Tranexamic acid mouthwash–A prospective randomized study of a 2-day regimen vs 5-day regimen to prevent postoperative bleeding in anticoagulated patients requiring dental extractions. Int J Oral Maxillofac Surg. 2003;32:504
  72. Carter G, Goss A, Lloyd J, et al. Tranexamic acid mouthwash versus autologous fibrin glue in patients taking warfarin undergoing dental extractions: A randomized prospective clinical study. J Oral Maxillofac Surg. 2003;61:1432
  73. Della Valle A, Sammartino G, Marenzi G, et al. Prevention of postoperative bleeding in anticoagulated patients undergoing oral surgery: Use of platelet-rich plasma gel. J Oral Maxillofac Surg. 2003;61:1275
  74. Halfpenny W, Fraser JS, Adlam DM. Comparison of 2 hemostatic agents for the prevention of postextraction hemorrhage in patients on anticoagulants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:257
  75. Zanon E, Martinelli F, Bacci C, et al. Safety of dental extraction among consecutive patients on oral anticoagulant treatment managed using a specific dental management protocol. Blood Coagul Fibrinolysis. 2003;14:27
  76. Barrero MV, Knezevic M, Martin MT, et al. Cirugia oral en pacientes en tratamiento con anticoagulantes orales (Pauta de actuacion). Medicina Oral. 2002;7:63
  77. Blinder D, Manor Y, Martinowitz U, et al. Dental extractions in patients maintained on oral anticoagulant therapy: Comparison of INR value with occurrence of postoperative bleeding. Int J Oral Maxillofac Surg. 2001;30:518
  78. Blinder D, Manor Y, Martinowitz U, et al. Dental extractions in patients maintained on continued oral anticoagulant: Comparison of local hemostatic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:137
  79. Campbell JH, Alvarado F, Murray RA. Anticoagulation and minor oral surgery: Should the anticoagulation regimen be altered?. J Oral Maxillofac Surg. 2000;58:131
  80. Cannon PD, Dharmar VT. Minor oral surgical procedures in patients on oral anticoagulants–A controlled study. Aust Dent J. 2003;48:115
  81. Devani P, Lavery KM, Howell CJ. Dental extractions in patients on warfarin: Is alteration of anticoagulant regimen necessary?. Br J Oral Maxillofac Surg. 1998;36:107
  82. Evans IL, Sayers MS, Gibbons AJ, et al. Can warfarin be continued during dental extraction? (Results of a randomized controlled trial). Br J Oral Maxillofac Surg. 2002;40:248
  83. Ramstrom G, Sindet-Pedersen S, Hall G, et al. Prevention of postsurgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants. J Oral Maxillofac Surg. 1993;51:1211
  84. Souto JC, Oliver A, Zuazu-Jausoro I, et al. Oral surgery in anticoagulated patients without reducing the dose of oral anticoagulant: A prospective randomized study. J Oral Maxillofac Surg. 1996;54:27
  85. Street AM, Leung W. Use of tranexamic acid mouthwash in dental procedures in patients taking oral anticoagulants. Med J Aust. 1990;153:630
  86. Sindet-Pedersen S, Ramstrom G, Bernvil S, et al. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. N Engl J Med. 1989;320:840
  87. Assael LA. Hemostasis is a shared responsibility. J Oral Maxillofac Surg. 2003;61:1377
  88. Weideman E. Risk assessment of long term post-operative bleeding following tooth extraction(s) in the pre-transplant liver failure patient. J Oral Maxillofac Surg. 2005;63(suppl 1):33
  89. Hirsh J, Dalen J, Anderson DR, et al. Oral anticoagulants: Mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest. 2001;119(suppl 1):8S
  90. Brickey DA, Lawlor DP. Transbronchial biopsy in the presence of profound elevation of the international normalized ratio. Chest. 1999;115:1667
  91. Wood JC, Conn HL. Prevention of systemic arterial embolism in chronic rheumatic heart disease by means of protracted anticoagulant therapy. Circulation. 1954;10:517
  92. Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery. N Engl J Med. 1997;336:1506
  93. Alexander R, Ferretti AC, Sorensen JR. Stop the nonsense not the anticoagulants: A matter of life and death. N Y State Dent J. 2002;68:24
  94. Gibbons AJ. Oral surgery in patients taking anticoagulant therapy. J Oral Maxillofac Surg. 2004;62:644
  95. Wood GD. Antibiotic prescribing and warfarin enhancement. Br Dent J. 1993;175:241
  96. Wood GD, Deeble T. Warfarin: Dangers with antibiotics. Dent Update. 1993;20:350
  97. Bandrowsky T, Vorono AA, Borris TJ, et al. Amoxicillin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82:610
  98. Malden N. The great warfarin debate. Br Dent J. 2003;195:2
  99. Lieblich S. Tranexamic acid rinses in anticoagulated patients. J Oral Maxillofac Surg. 1996;54:657
  100. Scully C, Wolff A. Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:57
  101. Sen P, Sen R. Re: Sugar AW et al: Can warfarin be continued during dental extraction? Results of a randomised controlled trial. Br J Oral Maxillofac Surg. 2003;41:132
  102. Mehra P, Cottrell DA, Bestgen SC, et al. Management of heparin therapy in the high-risk, chronically anticoagulated, oral surgery patient: A review and a proposed nomogram. J Oral Maxillofac Surg. 2000;58:198
  103. Johnson-Leong C, Rada RE. The use of low-molecular-weight heparins in outpatient oral surgery for patients receiving anticoagulation therapy. J Am Dent Assoc. 2002;133:1083
  104. Todd DW, Roman A. Outpatient use of low-molecular weight heparin in an anticoagulated patient requiring oral surgery: Case report. J Oral Maxillofac Surg. 2001;59:1090
  105. Jafri SM. Periprocedural thromboprophylaxis in patients receiving chronic anticoagulation therapy. Am Heart J. 2004;147:3
  106. Hewitt RL, Chun KL, Flint LM. Current clinical concepts in perioperative anticoagulation. Am Surg. Mar. 1999;65:270
  107. Zusman SP, Lustig JP, Bin Nun G. Cost evaluation of two methods of post tooth extraction hemostasis in patients on anticoagulant therapy. Community Dent Health. 1993;10:167
  108. Eckman MH, Beshansky JR, Durand-Zaleski I, et al. Anticoagulation for noncardiac procedures in patients with prosthetic heart valves (Does low risk mean high cost?). JAMA. 1990;263:1513
  109. Bloomer CR. Excessive hemorrhage after dental extractions using low-molecular-weight heparin (Lovenox) anticoagulation therapy. J Oral Maxillofac Surg. 2004;62:101

PII: S0278-2391(07)00327-8

doi: 10.1016/j.joms.2007.03.003

Journal of Oral and Maxillofacial Surgery
Volume 65, Issue 8 , Pages 1454-1460 , August 2007

Article Tools

* Image Usage & Resolution