Correlation of Two Different Local Hemostatic Modalities in Oral Surgery Patients with Oral Anticoagulants

Abstract

INTRODUCTION: The oral surgeons are frequently asked to manage patients who are receiving oral anticoagulants. The goal of treatment is to minimize the risk of hemorrhage while continuing to protect the patient against thromboembolism formation. The ordinary treatment includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. However, this practice may logically increase the risk of a potentially life-threatening thromboembolism. Thus, this issue is still controversial. Various protocols have been suggested for treating these patients, including substituting heparin for warfarin, decreasing the level of anticoagulation preoperatively, temporarily stopping the warfarin, and not altering the anticoagulant regimen at all.  There remains, however, no standard therapeutic approach, and currently it appears that each patient's treatment plan is individually tailored by his or her attending specialist.

AIM: The evidence from clinical trials and focused reviews supports continuing oral anticoagulation for patients needing dentoalveolar surgery. As long as the INR is within the therapeutic range and local hemostatic measures are taken following the surgery, these patients will have little chance of developing uncontrolled bleeding following the surgery. The aim of this study was to compare the clinical hemostatic effect of tranexamic acid mouthwash and resorbable oxicellulose dressing after oral surgery interventions in patients receiving continuous oral anticoagulant therapy

MATERIAL AND METHOD: A first group was consisted of 25 patients with a preoperative international normalized ratio (INR) in the range of 1.8 to 3.0. After the interventions was used 5% tranexamic acid mouthwashing for 2 minutes, 4 time daily during a postoperative period of 4days. The second group of 25 patients with a comparable INR range of 1.9 to 2.9 had oral surgical interventions performed and the socket(s) dressed with a resorbable oxycellulose dressing and sutured with a resorbable suture.

RESULTS: No discernible difference in the postoperative outcome with regard to hemorrhage was noted. Postoperative pain was reported more frequently in the group that used a resorbable oxycellulose dressing. Only 1 patient had significant postoperative bleeding. The risk of uncontrolled life threatening bleeding following dentoalveolar surgery is so low that it is not necessary to stop anticoagulation even for a short interval and risk thromboembolism in patients on oral anticoagulants.

CONCLUSIONS: Dental extractions can be performed without interruption in patients treated with oral anticoagulant. This study shows that in patients receiving oral anticoagulants whose INR is within the therapeutic range, the tranexamic acid mouthwash is as effective as the resorbable oxycellulose dressing in preventing post oral surgical hemorrhage. The results indicated that a combination of local antifibrinolytic therapy and a local hemostatic agent is effective in preventing postoperative bleeding after oral surgery in patients treated with anticoagulants. Local hemostasis will control the bleeding in the few patients who develop postsurgical bleeding.

Keywords: bleeding, oral anticoagulant, oral surgery, oxycellulose dressing, tranexamic acid.