Patients on VKA therapy require careful perioperative management and postoperative monitoring during dental extractions to prevent severe delayed bleeding.
Alerts clinicians to delayed bleeding risk in VKA patients post-extraction; leaves open optimal monitoring protocols for prospective validation.
A patient treated with a vitamin K antagonist (VKA) since the implantation of two mechanical heart valves developed acute anemia after the extraction of a tooth. This case report and data in the literature indicate a need for specific measures before, during, and after oral surgery in patients taking anticoagulant therapy: 1) the bleeding risk should be evaluated before the procedure. The INR should be measured routinely, 2) the procedure should be scheduled early in the week to allow an evaluation at the fibrinolysis peak, i.e., 48 to 72 hours after surgery, which is the time of greatest risk of delayed bleeding, 3) the surgical procedure should be appropriate for the elevated bleeding risk, 4) postoperative monitoring is of the most importance, as bleeding is usually delayed in patients on VKA therapy, 5) when poor treatment adherence is expected, day-hospital admission is useful to ensure that the postoperative protocol is implemented properly and to detect early bleeding. The treatment of post-extraction acute anemia includes local hemostasis protocol with the revision of the socket followed by red-blood-cell pack transfusion. A daily fluindione dosage control, and a normal hemoglobin level will allow the patient to leave the hospital.
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Aïche et al. (2014) studied this question.
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