From Volume 41, Issue 5, June 2014 | Pages 395-405
Post-operative haemorrhage is a recognized complication in dental practice. This may be more prevalent in patients taking anti-thrombotic medications. It is important that the dentist understands the mechanism of action of these drugs and how they may affect management of dental patients.
For many years, warfarin has been the most commonly used oral anticoagulant in the United Kingdom; however, as a long term medication it has disadvantages. This has led to the introduction of a number of new anticoagulant regimens that can impact on dental practice. Other medications, such as aspirin, are also used regularly for their anti-thrombotic effect. A clear understanding of oral anticoagulant therapy and the indications for treatment provision or suitable referral is important.
Prescribed medications are used to reduce the risk of a thrombo-embolic event. A thrombus is most likely to occur within a damaged vessel or heart wall. The pathologist Rudolph Virchow adopted a triad of risk factors for thrombo-embolism (Figure 1). These include:
The prevention and treatment of thrombo-embolism is the main indication for anticoagulant use. Table 1 shows the most common examples.
Some consideration should be given to the action of the different therapies available. They can be split into 3 main categories according to their action:
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