Oral surgery in patients on anticoagulant treatment without therapy interruption

Purpose: Conflicting opinions exist in literature concerning the management of oral surgery in patients on oral anticoagulants because no consensus on perioperative protocols is available, including precise guidelines regarding the need for therapy modification or withdrawal. The aim of this study was to evaluate bleeding complications associated with oral surgery performed on patients on oral anticoagulants without therapy modification or withdrawal but following a standardized comprehensive perioperative management protocol. Patients and Methods: Patients on oral anticoagulant therapy with warfarin and in need of oral surgery underwent a thorough general and oral clinical evaluation to assess thromboembolic and bleeding risk; 255 subjects who, on the morning of surgery, had INR values <= 5.5 were included in the study. An atraumatic surgical technique was carried out and all patients received postoperative careful instructions. Results: Five cases (1.96%) of bleeding complication were observed in patients with moderate to high thromboembolic and bleeding risk. Conclusion: The findings from this study suggest that a comprehensive perioperative management protocol for oral surgery in patients on oral anticoagulants including 1) thromboembolic and bleeding risk assessment, 2) an atraumatic surgical technique, and 3) postoperative careful instructions, can lead to safe and successful results with minimal complications. (c) 2007 American Association of Oral and Maxillofacial Surgeons