Dental interventions in oral antithrombotic therapy

Czech version

Authors: Juraj Deglovič ¹; Anna Remková ²
Authors‘ workplace: Katedra zubného lekárstva Lekárskej fakulty SZU, Bratislava ¹; REMEDIKA, s. r. o., Bratislava ²
Published in: Vnitř Lék 2023; 69(1): 31-36
Category: Review Articles
doi: https://doi.org/10.36290/vnl.2023.004

Overview

Dentists commonly encounter patients taking oral antithrombotic agents who require invasive dental procedures. Although antithrombotics can cause an increase in bleeding, there is consensus that treatment regimens with antiplatelet agents, older anticoagulants (warfarin) and direct oral anticoagulants should not be altered before routine dental procedures when the risk of bleeding is low. Thromboembolic risk of their discontinuing likely outweighs potential bleeding complications associated with surgery. Therefore, the risks of stopping or reducing these medications must be weighed against the potential consequences of prolonged bleeding, which can be controlled with local measures such as mechanical pressure, suturing, haemostatic agents or antifibrinolytics. Some patients who are taking antithrombotic medications may have additional comorbid conditions or receive other therapy that can increase the risk of prolonged bleeding after dental treatment. Where a patient is believed to be at high bleeding risk, the dentist should consider a consultation with the patient’s physician to discuss temporarily discontinuing the antithrombotic therapy.

Keywords:

warfarin – Antiplatelet therapy – bleeding – direct oral anticoagulants – Tooth extraction – dental procedures – oral anticoagulant therapy

Sources

1. Remková A, Remko M. Antitrombotiká v klinickej praxi. Samedi: Bratislava 2014: 318 strán. ISBN 978-80-970825-8-1.

2. American Dental Association 2020. Oral anticoagulant and antiplatelet medications and dental procedures. Available from: https://www.ada.org/resources/research/science‑and‑research‑institute/ oral‑health‑topics/ oral‑anticoagulant‑and‑antiplatelet‑medications‑and‑dental‑procedures

3. Kaplovitch E, Dounaevskaia V. Treatment in the dental practice of the patient receiving anticoagulation therapy. J Am Dental Association. 2019;150(7):P602-608.

4. Felix J, Chaban P, Ouanounou A. Dental management of patients undergoing antithrombotic therapy. J Can Dent Assoc. 2020; k17.

5. Scottish Dental Clinical Effectiveness Programme. Management of dental patients taking anticoagulants or antiplatelet drugs. Dental clinical guidance. August 2015. www. sdcep.org.uk/published‑guidance/ anticoagulants‑and‑antiplatelets).

6. Daly C. Dental note: Treating patients on new anticoagulant drugs. Aust Prescr. 2016;39(6):205-207.

7. Remková A, Deglovič J, Šupler M. Dental procedures in oral anticoagulation therapy. Dentálne výkony pri perorálnej antikoagulačnej liečbe. Cardiology Lett. 2020;29(3):154-159.

8. Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm Association Practical Guide on the use of non‑vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace. 2021;23(10):1612-1676.

9. Grines CL, Bonow RO, Casey DE, Jr., et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. J Am Dent Assoc. 2007; 138(5): 652-655/ Circulation. 2007;115(6):813-818.

10. Napenas JJ, Oost FC, DeGroot A, et al. Review of postoperative bleeding risk in dental patients on antiplatelet therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(4):491- 499.

11. Ockerman A, Bornstein MM, Leung YY, et al. Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta‑analysis. Int J Oral Maxillofac Surg. 2020;49(1):90-98.

12. Lu S‑Y, Lin L‑H, Hsue S‑S. Management of dental extractions in patients on warfarin and antiplatelet therapy. J Formos Med Assoc. 2018;117:979e986.

13. Lanau N, Mareque J, Giner L, et al. Direct oral anticoagulants and its implications in dentistry. A review of literature. J Clin Exp Dent. 2017;9(11):e1346-54.

14. Mauprivez C, Khonsari RH, Razouk O, et al. Management of dental extraction in patients undergoing anticoagulant oral direct treatment: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(5):e146-155.

15. Lusk KA, Snoga JL, Benitez RM, et al. Management of direct‑acting oral anticoagulants surrounding dental procedures with low‑to‑moderate risk of bleeding. J Pharm Pract. 2018;31(2):202-207.

16. Manfredi M, Dave B, Percudani D, et al. World workshop on oral medicine VII: Direct anticoagulant agents management for invasive oral procedures: A systematic review and meta‑analysis. Oral, DiS. 2019;25Suppl1:157-173.

17. Brennan Y, Ying Gu Y, Schifter M, et al. Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study. Res Pract Thromb Haemost. 2020; 4:278–284.

18. Clemm R, Neukam FW, Rusche B, et al. Management of anticoagulated patients in implant therapy: a clinical comparative study. Clin Oral Impl Res. 2016; 27(10):1274-1282.

19. Gorog DA, Gue YX, Chao T‑F, et al. Assessment andmitigation of bleeding risk in atrial fibrillation and venous thromboembolism: A Position Paper from the ESC Working Group on Thrombosis, in collaboration with the European Heart Rhythm Association, the Association for Acute CardioVascular Care and the Asia‑Pacific Heart Rhythm Society. Europace. 2022;00,1–28. https://doi.org/10.1093/europace/euac020

20. Hupp JR, Ellis E, Tucker MR. Contemporary oral and maxillofacial surgery. 6th ed. St. Louis, Mo.: Mosby; 87 s. ISBN 978-0-323-09177-0