Oral surgery in patients on anticoagulants without therapy interruption

Purpose: Conflicting opinions exist in literature concerning the management of oral surgery in patients on oral anticoagulants, since no consensus on perioperative protocols or guidelines on therapy modification or withdrawal are available. The aim of the present study was to evaluate bleeding complications associated to oral surgery performed in patients on oral anticoagulants without therapy modification or withdrawal but following a standardized comprehensive perioperative management protocol. Methods: 255 patients (mean age 67.8±9.5, range 27-89 years on anticoagulant therapy with warfarin and in need for oral surgery underwent a thorough general and oral clinical evaluation in order to assess thromboembolic and bleeding risk. Subjects who on the morning of surgery had PT-INR values ≤ 5.5 were included in the study. An atraumatic surgical technique was carried out and all patients received postoperative careful instructions. Results: 334 interventions were carried out on 255 patients. According to thromboembolic risk, 41 patients were classified as low risk, 115 moderate risk and 99 high risk. According to bleeding risk, 127 patients (189 interventions) were classified as low and 128 (145 interventions) as high risk. Preoperatory PT-INR were comprised between 1.3 and 5.4 (average 2.7±1.2). Five cases (1.96%) of bleeding complication were observed in patients with moderate to high thromboembolic and bleeding risk. Conclusions and Relevance: A comprehensive perioperative management protocol for oral surgery in patients on oral anticoagulants including (i) thromboembolic and bleeding risk assessment, (ii) an atraumatic surgical technique and (iii) postoperative careful instructions, can lead to safe and successful results with minimal complications.