OBJECTIVE: This study aimed to systematically review literature about the effect of alteration of the pharmacological regimen in adult patients using anticoagulants or antiplatelets who need minor oral surgery. MATERIAL AND METHODS: A search strategy was performed in three databases-PubMed-Medline, Scopus, and Embase-and included randomized clinical trials (either parallel or crossover), involving individuals under anticoagulant or antiplatelet therapy who underwent oral surgeries. Studies comprised two groups: those who stopped their medication prior to the dental procedure (control) or those who did not (test). Meta-analyses were conducted for the pooled risk ratio (RR) between the groups. Subgroup analyses were performed for anticoagulant and antiplatelet therapies. RESULTS: Thirteen studies were included. It was found that patients who did not stop therapy had 157% higher intraoperative bleeding occurrences (95%CI: 1.40-4.71). In the subgroup analysis, warfarinazed patients showed significantly higher occurrences of intraoperative bleeding when compared with the control (RR: 1.79; 95%CI: 1.00-3.21). Conversely, there was no statistically significant difference in postoperative bleeding between the groups (RR: 0.81; 95%CI: 0.54-1.22; p = 0.42). CONCLUSION: Minor oral surgeries can be safely performed in patients under antiplatelets or anticoagulants without drug regimen modification. Because these patients tend to bleed more during procedures, use of local hemostatic measures is strongly advised. CLINICAL RELEVANCE: Management of patients under antiplatelet or anticoagulant drugs is still challenging in clinical practice. However, clinicians may perform minor oral surgeries safely without changing the pharmacological regimen. Use of local hemostatic measures is strongly advised during these procedures.
OBJECTIVE: This study aimed to systematically review literature about the effect of alteration of the pharmacological regimen in adult patients using anticoagulants or antiplatelets who need minor oral surgery. MATERIAL AND METHODS: A search strategy was performed in three databases-PubMed-Medline, Scopus, and Embase-and included randomized clinical trials (either parallel or crossover), involving individuals under anticoagulant or antiplatelet therapy who underwent oral surgeries. Studies comprised two groups: those who stopped their medication prior to the dental procedure (control) or those who did not (test). Meta-analyses were conducted for the pooled risk ratio (RR) between the groups. Subgroup analyses were performed for anticoagulant and antiplatelet therapies. RESULTS: Thirteen studies were included. It was found that patients who did not stop therapy had 157% higher intraoperative bleeding occurrences (95%CI: 1.40-4.71). In the subgroup analysis, warfarinazed patients showed significantly higher occurrences of intraoperative bleeding when compared with the control (RR: 1.79; 95%CI: 1.00-3.21). Conversely, there was no statistically significant difference in postoperative bleeding between the groups (RR: 0.81; 95%CI: 0.54-1.22; p = 0.42). CONCLUSION: Minor oral surgeries can be safely performed in patients under antiplatelets or anticoagulants without drug regimen modification. Because these patients tend to bleed more during procedures, use of local hemostatic measures is strongly advised. CLINICAL RELEVANCE: Management of patients under antiplatelet or anticoagulant drugs is still challenging in clinical practice. However, clinicians may perform minor oral surgeries safely without changing the pharmacological regimen. Use of local hemostatic measures is strongly advised during these procedures.
Authors: James D Douketis; Alex C Spyropoulos; Frederick A Spencer; Michael Mayr; Amir K Jaffer; Mark H Eckman; Andrew S Dunn; Regina Kunz Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: Jason G Andrade; Atul Verma; L Brent Mitchell; Ratika Parkash; Kori Leblanc; Clare Atzema; Jeff S Healey; Alan Bell; John Cairns; Stuart Connolly; Jafna Cox; Paul Dorian; David Gladstone; M Sean McMurtry; Girish M Nair; Louise Pilote; Jean-Francois Sarrazin; Mike Sharma; Allan Skanes; Mario Talajic; Teresa Tsang; Subodh Verma; D George Wyse; Stanley Nattel; Laurent Macle Journal: Can J Cardiol Date: 2018-11 Impact factor: 5.223
Authors: Frederico Buhatem Medeiros; Ana Carolina Porrio de Andrade; Gabriella A M C Angelis; Valéria C L S Conrado; Lilia Timerman; Pedro Farsky; Luciano Lauria Dib Journal: J Oral Maxillofac Surg Date: 2011-07-29 Impact factor: 1.895
Authors: Eveline T Engelen; Roger Eg Schutgens; Evelien P Mauser-Bunschoten; Robert Jj van Es; Karin Pm van Galen Journal: Cochrane Database Syst Rev Date: 2018-07-02