Perioperative management of tooth extraction in patients with antiplatelet and anticoagulant treatment

Abstract

Patients on anticoagulant or antiplatelet treatment require close monitoring during extraction surgery because of the significant risk of postoperative bleeding. There is no consensus regarding the treatment of patients with anticoagulants, recently dentists opt for a conservative approach, in which the intervention takes place without interrupting the medication, and haemostasis is achieved through local measures. Discontinuation of anticoagulant treatment during oral surgery increases the risk of thromboembolic events through various mechanisms, such as INR (international normalized ratio), compensatory hypercoagulability and the post-thrombotic effect. Thus, patients are prone to the risk of pre- and postoperative arterial thromboembolism and postoperative venous thromboembolism if the INR value returns to normal shortly after discontinuation of treatment. This study aims to evaluate the haemorrhagic complications associated with dental extractions in patients under chronic anticoagulant treatment, with the modification of drug therapy and following a standard perioperative management protocol.