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Patients with bleeding disorders pose a challenge for dentists. Most of these conditions can be safely treated in the general dental practice. Patients who are on anticoagulants represent a large group of bleeding disorders. This article reviews the latest evidence in regard to managing those patients. Most of the articles reviewed seem to agree on the negligible risk of modification or interruption of oral anticoagulants when performing most dental treatments because a decreased risk of excessive bleeding might be associated with an increased risk of thrombo-embolic complications. However, extensive pre-operative assessment is essential to reduce the risk of serious complications.
Clinical Relevance: Patients with bleeding disorders pose a challenge for dentists. Adequate understanding of the underlying medical condition is essential to reduce the risk of dangerous complications.
Article
The normal haemostasis process involves three stages:
For normal homeostasis to be achieved, four biological factors should be intact:
Accordingly, bleeding disorders can be classified mainly into (Table 1):
This, of course, is in addition to other complementary factors such as fibrinolytic defects and other acquired factors.
This article will review how to manage dental patients who are on anticoagulant medication.
In general, anticoagulant medications are prescribed for prophylaxis (eg prevention of deep vein thrombosis (DVT), pulmonary embolism (PE) in high risk patients or prevention of strokes in chronic AF or prosthetic heart valves), or therapeutic treatment of venous thrombo-embolic disorders like DVT or PE.
Common anticoagulants used in the UK include (in order of the most common): aspirin, warfarin, clopidogrel, dipyridamole and heparin.
Warfarin is commonly prescribed for prophylaxis or therapeutic treatment of thrombo-embolic disease and arrhythmias. It acts as a vitamin K antagonist so it affects the synthesis of active factors II, VII, IX, X and protein C. This process takes 3 to 4 days and it prolongs both the prothrombin time (PT) and activated partial thromboplastin time (APTT).
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