European Journal of Biomedical and Pharmaceutical Sciences

UPDATE IN THE KNOWLEDGE OF ANTIPLATELET AGENTS, VITAMIN K ANTAGONIST ANTICOAGULANTS AND DIRECT ORAL ANTICOAGULANTS IN DENTISTRY

Carmen López-Carriches*, Mª Isabel Leco-Berrocal, Ricardo Bahram-Taheri
Juan López-Quiles

ABSTRACT

Background: Clinical guidelines are proposed to avoid postoperative bleeding in patients taking antiplatelet drugs, such as acetylsalicylic acid or clopidogrel. Also, guidelines for the use of anticoagulants such as heparin and classic vitamin K antagonists (acenocoumarol and warfarin). Recommendations are additionally given for the not so new direct oral anticoagulants such as dabigatran, rivaroxaban, apixaban and edoxaban. Antiplatelet and anticoagulation therapy have traditionally been suspended before oral surgery treatments due to fear of oral bleeding. Material and Methods: The following electronic databases have been searched: Pubmed Medline and the Chochrane Library Plus. Articles published in the last 12 years in Spanish and English about prevention of bleeding in patients taking antiplatelet or anticoagulant drugs were included. Results: Many recent studies have been found proposing differentiated protocols according to the risk of thromboembolism and the probability of bleeding of the patient. The actual tendency is not to suspend the treatment of the patient to prevent cardiovascular complication, especially in simple procedures. Also, it is recommended to apply local measures of haemostasis such as suture and antifibrinolytics. Conclusions: The actual trend is to maintain the pharmacological treatment or to remove it the least possible time. We have to carefully overcome the risk of bleeding depending on the risk of cardiovascular events or arterial or venous thrombosis carrying these a higher risk for the patient. Also, we must be familiar with these antithrombotic drugs which are increasingly being used by patients. However, the physician should be the one to modify the medication in case the procedure to be performed has a high risk of bleeding. Local hemostatic measures are recommended to prevent postoperative bleeding.

Keywords: Haemostasis, oral surgery, tooth extraction, anticoagulation, antiplatelets agents, direct oral anticoagulants, heparin, vitamin k antagonists.