Antithrombotic medication represents a challenge for any dental practitioner due to the possible hemorrhage complications that can be associated with an important morbidity/mortality risk. The objective of the present literature review is to establish which dental procedures have a risk to increase the incidence of hemorrhage in patients on antithrombotic therapy.
Materials and methods
A systematic review of the literature was conducted using MEDLINE, PubMed, and DiscoverEd databases. The inclusion criteria used were as follows: Current antithrombotic therapy, invasive dental procedures, and postoperative incidence of bleeding follow-up.
A total of 14 clinical studies and 5 literature reviews were selected after the initial screening. The incidence of hemorrhage was assessed for dental implant placements, dental extractions, simple dental procedures, and periodontal treatment.
A well-coagulated patient can safely have invasive dental procedures in a hospital environment or nonhospital setting without having their antithrombotic therapy altered. Local hemostatic measures can offer a proper hemorrhage control.
How to cite this article
Pirlog CD, Pirlog AM, Maghiar T. A Systematic Review of the Hemorrhage Risk for Patients on Antithrombotic Medication after Dental Procedures. World J Dent 2018;9(1):59-67.
Antithrombotic drugs: pharmacology and implications for dental practice. Anesth Prog 2013 Summer;60(2):72-80.
Anticoagulant, thrombolytic, and antiplatelet drugs. In: Hardman JG, Limbird LE, editors. Goodman and Gilman's the pharmacological basis of therapeutics. 9th ed. New York (NY): McGraw-Hill; 1996. pp. 1341-1354.
Rationalizing cyclooxygenase (COX) inhibition for maximal efficacy and minimal adverse events. Am J Med 1999 Dec;107(6A):78-88.
Surgical management of the primary care patient on warfarin. Liverpool: North West Medicines Information Centre; 2007.
Management of dental patients taking anticoagulants and antiplatelet drugs: dental clinical guidance. Dundee: SDCEP; 2015. p. 6.
I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet trialists’ collaboration. BMJ 1994 Jan;308(6921):81-106.
Antiplatelet drugs: a review of their pharmacology and management in the perioperative period. Anesth Analg 2011 Feb;112(2):292-318.
Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006 Apr;354(16):1706-1717.
The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. Br J Clin Pharmacol 2007 Sep;64(3):292-303.
Oral anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 2012 Feb;141(Suppl 2):e44S-e88S.
Dabigatran etexilate — a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 2010 Jun;103(6):1116-1127.
Safety, pharmacodynamics, and pharmacokinetics of single doses of BAY 59-7939, an oral, direct factor Xa inhibitor. Clin Pharmacol Ther 2005 Oct;78(4):412-421.
Adjusted-dose warfarin versus aspirin for preventing stroke in patients with atrial fibrillation. Ann Intern Med 2007 Oct;147(8):590-592.
Hemorrhagic complications of anticoagulant and thrombolytic treatment: American college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest 2008 Jun;133(Suppl 6):257S-298S.
Dental surgery in anticoagulated patients. Arch Intern Med 1998 Aug;158(15):1610-1616.
Anticoagulated patients and oral surgery. Arch Intern Med 2003 May;163(10):1242.
Haemostasis. Part 1: the management of post-extraction haemorrhage. Dent Update 2014 May;41(4):290-292, 294-296.
Guidelines for the management of patients on oral anticoagulants requiring dental surgery. Br Dent J 2007 Oct;203:389-393.
Tranexamic acid in control of haemorrhage after dental extraction in haemophilia and Christmas disease. Br Med J 1972 May;2(5809):311-313.
Safety of dental implant surgery in patients undergoing anticoagulation therapy: a prospective case-control study. Clin Oral Implants Res 2011 Feb;22(2):151-156.
Randomized, prospective trial comparing bridging therapy using low-molecular-weight heparin with maintenance of oral anticoagulation during extraction of teeth. J Oral Maxillofac Surg 2009 May;67(5):990-995.
The effects of combined oral anticoagulant-aspirin therapy in patients undergoing tooth extractions: a prospective study. J Am Dent Assoc 2012 Jul;143(7):771-776.
Risk factors for bleeding after oral surgery in patients who continued using oral anticoagulant therapy. J Am Dent Assoc 2015 Jun;146(6):375-381.
Risk of bleeding after dent alveolar surgery in patients taking anticoagulants. Br J Oral Maxillofac Surg 2014 Mar;52(3):e15-e19.
Management of anticoagulated patients in implant therapy: a clinical comparative study. Clin Oral Implants Res 2016 Oct;27(10):1274-1282.
Minor oral surgical procedures in patients on oral anticoagulants — a controlled study. Aust Dent J 2003 Jun;48(2):115-118.
Dental extractions in patients on warfarin: Is alteration of anticoagulant regime necessary? Br J Oral Maxillofac Surg 1998 Apr;36(2):107-111.
Dental implant surgery in patients in treatment with the anticoagulant oral Rivaroxaban. Clin Oral Implants Res 2016 Jun;27(6):730-733.
Dental implant surgery in patients in treatment by dabigatran. Clin Oral Implants Res 2016 Jan.
Comparison of the effects of warfarin and heparin on bleeding caused by dental extraction: a clinical study. Oral Maxillofac Surg 2011 Oct;69(10):2500-2507.
Management of dental extraction in patients undergoing anticoagulant oral direct treatment: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2016 Nov;122(5):e146-e155.
Hemostatic management for periodontal treatments in patients on oral antithrombotic therapy: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009 Dec;108(6):889-896.
Safety of dental extraction among consecutive patients on oral anticoagulant treatment managed using a specific dental management protocol. Blood Coagul Fibrinolysis 2003 Jan;14(1):27-30.
Dabigatran: a new oral anticoagulant. Guidelines to follow in oral surgery procedures. A systematic review of the literature. Med Oral Patol Oral Cir Bucal 2016 Nov;21(6):e679-e688.
Dental surgery for patients on anticoagulant therapy with warfarin: a systematic review and meta-analysis. Can Dent Assoc 2009 Feb;75(1):41.
Management recommendations for invasive dental treatment in patients using oral antithrombotic medication, including novel oral anticoagulants. Oral Surg Oral Med Oral Pathol Oral Radiol 2013 Dec;116(6):709-716.
Dental surgery in anticoagulated patients — stop the interruption. Oral Surg Oral Med Oral Pathol Oral Radiol 2015 Feb;119(2):136-157.
Should oral anticoagulant therapy be continued during dental extraction? A meta-analysis. BMC Oral Health 2016 Aug;16(1):81.
Oral surgery for patients on anticoagulant therapy: current thoughts on patient management. Dent Clin North Am 2012 Jan;56(1):25-41.
Perioperative management of antithrombotic therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 2012 Feb;141(Suppl 2):e326S-e350S.
American heart association/American college of cardiology foundation guide to warfarin therapy. Circulation 2003 Apr;107(12):1692-1711.