Alteration of oral anticoagulants in routine dental extraction: A literature review

The perioperative managment of oral anticoagulant therapy during dental extractions requires a careful risk-benefit analysis. The rationale to prevent hemorrhagic complications at the surgical site must be weighed against the thromboembolic hazard associated with discontinuing essential anticoagulation. This review aims to provide a thorough overview of current evidence on managing patients receiving oral anticoagulants, including direct oral anticoagulants (DOACs), during tooth extraction. Relevant literature has been reviewed from 1993 to 2023, in order to evaluate discrete management strategies, including temporary discontinuation, heparin bridging, dose adjustment, and continuation of therapy with adjunctive local hemostatic measures. A special emphasis has been provided to the evolving role of DOACs compared to traditional warfarin therapy. To improve retrieval sensitivity and specificity, the search strategy used both MeSH terms and free-text keywords in conjunction with Boolean operators (AND, OR). Oral anticoagulants, direct oral anticoagulants, warfarin, tooth extraction, perioperative management, bleeding risk, thromboembolism were the relevant search terms used. Though clinical studies suggest that there is an increased possibility of thromboembolic complication associated with routine cessation of anticoagulants prior to dental extraction. However, local hemostatic measures have been proven efficacious in maintaining oral anticoagulant therapy: Current trends support maintaining anticoagulant therapy. DOACs, with their predictable pharmacokinetics and lower interaction profile, demonstrate comparable or superior safety outcomes compared to warfarin, though unpredictability remains regarding their optimal perioperative management. In order to manage patients on oral anticoagulants therapy during dental extraction a diligent, evidence-based approach is required. For safeguarding most patients, local hemostatic measures have been used along with the oral anticoagulation therapy and thus this review provides dental practitioners with practical guidance to optimize patient safety and clinical outcomes.