OBJECTIVES: Oral anticoagulation therapy (OAT) with vitamin K inhibitors protects the patients from thromboembolic events. It may however lead to excessive hemorrhage during and after an oral surgery procedure. The aim of this systematic review was to evaluate the justifications to reduce, withdraw, or alter OATs prior to minor oral surgery procedures to manage bleeding events. MATERIALS AND METHODS: A systematic MEDLINE search was conducted for clinical studies in English or German language from 1994 to 2014 comparing patients treated with OAT, without OAT, as well as patients with altered OAT for oral surgery purposes. Relevant outcome parameters were: postoperative local hemostasis, bleeding episodes, occurrence of thromboembolic events, and other complications due to the anticoagulation medication. A hand search for references cited in the identified publications completed the review. RESULTS: After screening of 1755 abstracts, 16 clinical studies were identified according to the selection criteria. Due to the heterogeneity of the obtained data, aggregation and synthesis were not possible. There was no significant difference in bleeding events comparing patients under continued OAT to those with reduced, altered, and/or discontinued OAT medications. Minor bleeding events in the test and control groups were successfully stopped with local measures. However, no superiority of a single hemostatic measure could be identified. Neither the international normalized ratio (INR), within the therapeutic range (2-4), nor the extent of the minor oral surgery procedure had an influence on postoperative bleeding episodes. DISCUSSION: There is strong evidence that OAT patients undergoing minor oral surgery should not discontinue their medication in order to prevent thromboembolic complications. CLINICAL RELEVANCE: Nonetheless, INR should be less than 4, local hemostatic measures are of high importance and patients need to be instructed and closely monitored as minor bleedings might occur more often in OAT patients.
OBJECTIVES: Oral anticoagulation therapy (OAT) with vitamin K inhibitors protects the patients from thromboembolic events. It may however lead to excessive hemorrhage during and after an oral surgery procedure. The aim of this systematic review was to evaluate the justifications to reduce, withdraw, or alter OATs prior to minor oral surgery procedures to manage bleeding events. MATERIALS AND METHODS: A systematic MEDLINE search was conducted for clinical studies in English or German language from 1994 to 2014 comparing patients treated with OAT, without OAT, as well as patients with altered OAT for oral surgery purposes. Relevant outcome parameters were: postoperative local hemostasis, bleeding episodes, occurrence of thromboembolic events, and other complications due to the anticoagulation medication. A hand search for references cited in the identified publications completed the review. RESULTS: After screening of 1755 abstracts, 16 clinical studies were identified according to the selection criteria. Due to the heterogeneity of the obtained data, aggregation and synthesis were not possible. There was no significant difference in bleeding events comparing patients under continued OAT to those with reduced, altered, and/or discontinued OAT medications. Minor bleeding events in the test and control groups were successfully stopped with local measures. However, no superiority of a single hemostatic measure could be identified. Neither the international normalized ratio (INR), within the therapeutic range (2-4), nor the extent of the minor oral surgery procedure had an influence on postoperative bleeding episodes. DISCUSSION: There is strong evidence that OATpatients undergoing minor oral surgery should not discontinue their medication in order to prevent thromboembolic complications. CLINICAL RELEVANCE: Nonetheless, INR should be less than 4, local hemostatic measures are of high importance and patients need to be instructed and closely monitored as minor bleedings might occur more often in OATpatients.
Authors: Henning Hanken; Alexander Gröbe; Max Heiland; Ralf Smeets; Lan Kluwe; Johannes Wikner; Robert Koehnke; Ahmed Al-Dam; Wolfgang Eichhorn Journal: Clin Oral Investig Date: 2015-10-26 Impact factor: 3.573
Authors: Rogério Heládio Lopes Motta; Cristiane de Cássia Bergamaschi; Natalia Karol de Andrade; Caio Chaves Guimaraes; Juliana Cama Ramacciato; Jimmy de Oliveira Araújo; Luciane Cruz Lopes Journal: BMJ Open Date: 2017-12-19 Impact factor: 2.692
Authors: Guido Galletti; Fortunato Alfonsi; Angelo Raffaele; Nicola Alberto Valente; Sibylle Chatelain; Roni Kolerman; Chiara Cinquini; Stefano Romeggio; Giovanna Iezzi; Antonio Barone Journal: Int J Environ Res Public Health Date: 2020-06-26 Impact factor: 3.390
Authors: Mayte Buchbender; Felix Rößler; Marco R Kesting; Gesche Frohwitter; Werner Adler; Andrea Rau Journal: BMC Oral Health Date: 2021-03-05 Impact factor: 2.757