Key result
Continuing oral anticoagulation during dental procedures avoids excess bleeding, whereas heparin bridging increases bleeding risk.
Why the study?
There is a paucity of data regarding maintaining oral anticoagulation, especially novel oral anticoagulants, around the time of specific dental procedures.
Does continuing oral anticoagulation increase bleeding risk in patients undergoing dental procedures compared to stopping or bridging?
Systematic Review
Does continuing oral anticoagulation increase bleeding risk in patients undergoing dental procedures compared to stopping or bridging?
Continuing oral anticoagulation during common dental procedures appears safe and does not increase bleeding risk, whereas heparin bridging increases bleeding.
Answers are grounded in this paper and cite their sources.
May support continuing anticoagulation for dental procedures; leaves open need for higher-level RCTs to guide practice.
Currently, the number of patients on oral anticoagulation is increasing. There is a paucity of data regarding maintaining oral anticoagulation (especially novel oral anticoagulants) around the time of specific dental procedures. A dentist has three options: either to stop anticoagulation, to continue it, or to bridge with heparin. A systematic review of 10 clinical trials was conducted to address this issue. It was found that continuing anticoagulation during dental procedures did not increase the risk of bleeding in most trials. Although none of the studies reported a thromboembolic event after interruption of anticoagulation, the follow-up periods were short and inconsistent, and the heightened thromboembolic risk when stopping anticoagulation is well known in the literature. Heparin bridging was associated with an increased bleeding incidence. We recommend maintaining oral anticoagulation with vitamin K antagonists and novel oral anticoagulants for the vast majority of dental procedures along with the use of local hemostatic agents.
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Chahine et al. (2019) conducted a systematic review in Patients on oral anticoagulation undergoing dental procedures. Continuing oral anticoagulation vs. Stopping anticoagulation or heparin bridging was evaluated on Bleeding risk and thromboembolic events. Continuing oral anticoagulation during dental procedures did not increase bleeding risk in most trials, whereas heparin bridging was associated with increased bleeding incidence.
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