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Stomatologia 2009, 66(2):43-51
Review
ORAL SURGERY IN PATIENTS ON ANTIPLATELET OR ANTICOAGULANT THERAPY
E. MATOULAS, I. NAZAROGLOU, D. CHARITOUDI, S. PITSIAVAS, TH. LILLIS
SUMMARY Cardiovascular conditions represent the main cause of death in the world population and are related to an increased risk for thromboembolic complications. Antiplatelet and anticoagulant agents have been extensively researched and developed as potential therapies in the prevention and management of arterial and venous thrombosis. On the other hand, antiplatelet and anticoagulant drugs have also been associated with an increase in the bleeding time and risk of postoperative hemorrhage. Because of this, there is a widespread belief among dental practitioners and physicians in which patients must discontinue the antithrombotic therapy before oral surgery procedures, in order to prevent serious hemorrhagic complications. However, stopping this medication exposes the patient to vascular problems, with the potential for significant morbidity and even mortality. Furthermore, the literature does not support routine discontinuation of antithrombotic therapy for dental patients. In conclusion, most recent studies do not recommend reducing or interrupting the antithrombotic medication prior to tooth extraction, provided therapeutic INR levels or bleeding time are maintained, with emphasis on the atraumatic surgical technique and on the application of local measures such as alveolus compression, suturing and tranexamic acid mouthwashes, for the control of hemostasia.
KEY WORDS: Oral surgery, Dental extraction, Antiplatelets, Anticoagulants.
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