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Perioperative Management of Dental Patients on Anticoagulants

  • Michael J. Wahl
Chapter

Abstract

When continuously anticoagulated patients present for dental surgery, a decision must be made to continue anticoagulation and risk bleeding complications or to interrupt anticoagulation and risk embolic complication like stroke or heart attack. The incidence and morbidity of postdental bleeding complications in anticoagulated patients have been overestimated, and at the same time the increased embolic risks when anticoagulation has been interrupted have been underestimated. A search of the literature reveals that of more than 7376 anticoagulated patients undergoing 14,879 surgical procedures including 13,703 extractions, there were only about 486 bleeding complications (6% of patient visits), of which only 33 (0.4% of patients and visits) required more than local measures for hemostasis. On the other hand, there have been at least 3278 dental patients whose anticoagulation was interrupted for at least 3380 appointments. A total of 29 of these patients (0.9% of patients or visits) have had embolic complications after interruption, including 7 fatalities (0.2% of patients or visits). As a result, therapeutic anticoagulation levels should not be interrupted for dental surgery.

Keywords

Anticoagulants/administration & dosage Blood Loss, Surgical/prevention & control Contraindications Dental Care for Chronically Ill Hemostasis, Surgical Oral Hemorrhage/etiology Oral Hemorrhage/prevention & control Oral Surgical Procedures Risk Factors Thromboembolism/etiology Thromboembolism/prevention & control 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Michael J. Wahl
    • 1
  1. 1.Christiana Care Health SystemWilmingtonUSA

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