Stopping aspirin and warfarin for dental procedures: time for review

ABSTRACT

Surgical management of patients on anticoagulants is poorly understood in all fields of medicine and not just dentistry. Dental management of patients receiving oral anticoagulants is still controversial, a decision. must be made whether to continue or interrupt the anticoagulants. The traditional management entails the interruption of anticoagulant therapy for dental surgery to prevent hemorrhage. However, this practice may increase the risk of a potentially life-threatening thromboembolism. The aim of this paper is to review the evidence of this controversial issue and to highlight the areas of major concern. The pertinent literature was reviewed and all available evidence collected from Medline. Those schedules in which the oral anticoagulation was not modified preoperatively and an antifibrinolytic agent was applied locally both during and after surgery were not associated with a significantly higher odds ratio of bleeding complications than those in whom oral anticoagulation therapy was stopped before surgery. The existing evidence suggests that many patients can safely undergo routine outpatient oral surgical procedures without alteration of their regular therapeutic anticoagulation regimens and without additional medical intervention