Cardiology Letters 2020, 29(3):154-159

Dental procedures in oral anticoagulation therapy

Remková A^{1, 2}, Deglovič J^{3, 4}, Šupler M³

¹ I. interná klinika Dionýza Diešku, Univerzitná nemocnica Bratislava

² REMEDIKA s.r.o., Bratislava

³ Katedry zubného lekárstva LF SZU

⁴ SYDENT zubné ambulancie, Bratislava, Slovenská republika

Temporary interruption of chronic oral anticoagulation by warfarin or non-vitamin K antagonists (NOAC) due to the bleeding risk associated with minor dental surgery may lead to an elevated risk of thromboembolism. It is not necessary to interrupt oral anticoagulation for most minor surgical procedures and those procedures where bleeding is easily controllable. The risk of clinically significant bleeding in patients on anticoagulant treatment by warfarin and with a stable anticoagulation in the therapeutic range (INR 2-3) is very small. Warfarin should not be discontinued in the majority of patients requiring outpatient dental surgery including dental extraction. In patients placed on NOAC, these procedures can be performed 12-24 h after its last intake. It may be practical to have the intervention scheduled 18-24 h after the last NOAC intake, and then restart it 6 h later (skipping one dose of dabigatran or apixaban and no dose of edoxaban or rivaroxaban). Emerging data clearly points to harms of heparin bridging therapy periprocedurally, with a multi-fold increase in bleed risk. The risk of bleeding in patients on oral anticoagulants undergoing dental surgery may be minimised by local haemostatic measures.

Keywords: anticoagulation therapy; warfarin; direct oral anticoagulant drugs; dental surgery; local haemostatic measures

Published: March 1, 2020  Show citation