The use of low-molecular-weight heparins in outpatient oral surgery for patients receiving anticoagulation therapy.

BACKGROUND: When planning oral surgery, dentists occasionally will have patients who first need to have their anticoagulation regimen altered. To minimize the side effects and not adversely affect the patient's health, therapeutic anticoagulation should be interrupted for as short a time as possible. Low-molecular-weight heparins, or LMWHs, recently have emerged as an alternative in the management of patients whose anticoagulant status should not be modified for lengthy periods. CASE DESCRIPTION: A 72-year-old man, who had a history of deep venous thrombosis, needed to have 19 teeth extracted and an alveoloplasty performed. An LMWH was substituted for warfarin a few days before surgery, and it was withheld from the patient for only a few hours the day of the surgery. CLINICAL IMPLICATIONS: LMWHs are administered on an outpatient basis and do not require hospitalization, as does unfractionated heparin. As a result, they are more cost-effective and offer greater convenience than heparin therapy. Depending on the procedure and the degree to which patients are medically compromised, dentists may not feel comfortable treating patients who continuously receive anticoagulation therapy. As a result, patients' physicians may prescribe LMWH injections to be administered by patients, family members or caregivers to more safely manage the patients' care during oral surgery. As part of the health care team, dentists must be familiar with LMWH and its use to help guide patients safely through treatment.