Purpose: In general clinical practice, the oral and maxillofacial surgeon is frequently required to treat patients on anticoagulant therapy. The purpose of this paper is to review the literature in order to provide evidence-based guidelines for the management of anticoagulated patients undergoing oral and maxillofacial surgery.
Materials and Methods: Literature published over the past 40 years was reviewed. The management of patients on anticoagulant therapy as well as laser-assisted oral and maxillofacial surgery is discussed.
Results: Currently, the continuation of anticoagulant therapy is strongly encouraged when INR is within the therapeutic range and meticulous local hemostatic measures are taken.
Conclusion: It may be concluded that the risk of postoperative bleeding is outweighed by the higher risk of thromboembolism after withdrawal of the anticoagulant therapy and thus continuation of the anticoagulant regimen is encouraged. Laser-assisted oral and maxillofacial surgery in daily practice has enabled surgeons to achieve controlled hemostasis and minimize intra- and postoperative hemorrhage without discontinuing anticoagulants.
Keywords: hemostasis, CO2, diode, Nd:YAG, Er:YAG-YSGG, anticoagulants, oral and maxillofacial surgery.
Discussion:The performance of oral and maxillofacial surgery on patients who are taking oral anticoagulants remains
quite a controversial issue. Especially in routine oral surgery, the formation of a coagulum is conditio sine qua non for the postoperative differentiation of cells and hence for the healing pattern of the intraoral wounds. In contrast, the formation of a clot in the periphery of the cardiovascular system has to be inhibited in order to minimize the possibility of an ischemic episode. Postoperative bleeding occurs even in healthy individuals, let alone in the compromised anticoagulant patient. Hence, both the physician and oral and maxillofacial surgeon face a dilemma.23,24 Should one risk postoperative bleeding by continuing the anticoagulant regimen during surgery, or a life threatening thromboembolic event if medication is discontinued prior to oral surgical procedures?
Alteration of the regimen is associated with an increased risk of thromboembolism.29,42,44. Many studies have demonstrated that oral surgical procedures can be performed safely if the INR is within therapeutic range (INR < 4), and local hemostatic agents such as sutures and Surgicel are applied afterwards to prevent postoperative bleeding.4,22,25,33,38-48.
Today, there is a growing tendency among dental surgeons not to alter the medication routine.
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