Oral and maxillofacial surgery in patients on anticoagulant or antiplatelet
therapy: Current thoughts
Stavros VASSILIOU, Veronika PAPAKOSTA
Department of Oral and Maxillofacial Surgery at Attikon Hospital, Medical School University of Athens, Greece. (Head: Professor E. Vairaktaris)
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 2, 65-76
SUMMARY: Nowadays the trend is not to interrupt anticoagulants or antiplatelet drugs for minor oral surgery; They can be safely performed when the INR is 2-4. The suturing of the wound and the use of hemostatic agents reduces the possibility of postoperative bleeding. In cases of major maxillofacial interventions, the shortest possible interruption of anticoagulants is recommended in order to avoid the risk of thrombosis. The same applies to aspirin, and in cases of dual therapy (aspirin and clopidogrel) discontinuation of clopidogrel and low dose of aspirin are recommended. In case of excessive bleeding, administration of clotting factors or fresh platelets is recommended when the patient is on anticoagulants or antiplatelets respectively. In this literature study we report the older and the newer anticoagulants (dabigatran and rivaroxaban) and antiplatelet drugs (prasugrel) as well as the surgical management of patients who take them.
KEY WORDS: oral and maxillofacial surgery; anticoagulants; antiplatelet drugs;
REFERENCES
Aframian DJ, Lalla RV, Peterson DE:.Management of dental patients taking common hemostasis- altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 103:1-11, 2007
Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G.: Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest: 141: e44S–88, 2012 doi: 10.1378/chest.11-2292
Aldridge E, Cunningbam LL.: Current Thoughts on Treatment of Patients Receiving Anticoagulation Therapy. J Oral Maxillofac Surg 68:2879-2887, 2010 Ardekian L, Gaspar R, Peled M, Brener B, Laufer D.: Does low-dose aspirin therapy complicate oral surgical procedures? JADA. 131:331- 335, 2000
Bajkin BV, Popovic SL, Selakovic SD.: Randomized, prospective trial comparing bridging therapy using low-molecularweight heparin with maintenance of oral anticoagulation during extraction of teeth. J Oral Maxillofac Surg. 67:990–995, 2009
Blinder D, Manor Y, Martinowitz U, Taicher S, Hashomer T.: Dental extractions in patients maintained on continued oral anticoagulant: Comparison of local hemostatic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:137-140, 1999
Brennan MT, Valerin MA, Noll JL, Napeñas JJ, Kent ML και συν: Aspirin use and post-operative bleeding from dental extractions. J Dent Res. 87:740-744, 2008 CAPRIE Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 348:1329-1339, 1996
Cardona-Tortajada F, Sainz-Gómez E, Figuerido-Garmendia J, de Robles-Adsuar AL, Morte-Casabó A. και συν: Dental extractions in patients on antiplatelκαι therapy. A study conducted by the Oral Health Department of the Navarre Health Service (Spain). Med Oral Patol Oral Cir Bucal. 14:e588-592, 2009 Castellone DD, Van Cott EM.: Laboratory monitoring of new anticoagulants. Am J Hematol 85:185-187, 2010 Danos EA. Apparent potentiation of warfarin activity by tetracycline. Clin Pharmacol 11:806-808, 1992
Dewan K, Bishop K, Muthukrishnan A.: Management of patients on warfarin by general dental practitioners in South West Wales: continuing the audit cycle. Br Dent J. 206:E8. discussion 214–215, 2009 doi: 10.1038/sj.bdj.2009.112
Douketis JD, Berger PB, Dunn AS, Jaffer AK, Spyropoulos AC, Becker RC, Ansell J. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: 299S–339S, 2008 doi: 10.1378/chest.08-0675
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK και συν: Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 141(Suppl 2):e326S-50S, 2012 doi: 10.1378/chest.11-2298
du Breuil AL, Umland EM.: Outpatient management of anticoagulation therapy. Am Fam Physician. 75:1031–1042, 2007
Dunn AS, Spyropoulos AC, Turpie AG. Bridging therapy in patients on long-term oral anticoagulants who require surgery: the Prospective Peri-operative Enoxaparin Cohort Trial (PROSPECT). J Thromb Haemost. 5:2211–2218, 2007
Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA και συν: ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 110: e340–437, 2004
Eisele R, Melzer N, Englert C, Bramlage P, Spannagl M.: Bridging with the Low molecular weight heparin certoparin in patients requiring temporary discontinuation of oral anticoagulation – the non-interventional, retrospective REMEMBER study. Thrombosis Research 130:788–792, 2012
Fijnheer R, Urbanus RT, Nieuwenhuis HK. [Withdrawing the use of acetylsalicyclic acid prior to an operation usually not necessary]. Ned Tijdschr Geneeskd 147:21-25, 2003
Firriolo JF, Hupp WS. Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol 113:431- 441, 2012
Garcia D, Libby E, Crowther MA. The new oral anticoagulants. Blood 115:15-20, 2010
Grines CL, Bonow RO, Casey DE Jr, Gardner TJ, Lockhart PB και συν: Prevention of premature discontinuation of dual antiplatelκαι therapy in patients with coronary artery stents. A science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation 115:813-818, 2007a
Grines CL, Bonow RO, Casey DE Jr, Gardner TJ, Lockhart PB και συν: Prevention of premature discontinuation of dual antiplatelκαι therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Catheter Cardiovasc Interv. 69:334-340, 2007b
Halfpenny W, Fraser JS, Adlam DM. Comparison of 2 hemostatic agents for the prevention of postextraction hemorrhage in patients on anticoagulants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 92:257-259, 2001
Harrington RA, Becker RC, Ezekowitz M, Meade TW, O’Connor CM και συν: Antithrombotic therapy for coronary artery disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 513S–48S, 2004
Harrison P, Robinson MS, Mackie IJ, Joseph J, McDonald SJ και συν: Performance of the platelκαι function analyser PFA-100 in testing abnormalities of primary haemostasis. Blood Coagul Fibrinolysis. 10:25-31, 1999 Heit JA. Perioperative Management of the Chronically Anticoagulated Patient. J Thromb Thrombolysis 12: 81-87, 2001
Hirsh J, Dalen J, Anderson DR, Poller L, Bussey H και συν: Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 119: suppl, 8S-21S, 2001
Hirsh J, Fuster V, Ansell J, Halperin JL.: American Heart Association/ American College of Cardiology Foundation guide to warfarin therapy. Circulation 107:1692–1711, 2003
Jeske AH, Suchko GD.: Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment. JADA. 134:1492–1497, 2003
Jiménez Y, Poveda R, Gavaldá C, Margaix M, Sarrión G.: An update on the management of anticoagulated patients programmed for dental extractions and surgery. Med Oral Patol Oral Cir Bucal. 13:E176-179, 2008
Johnson-Leong C, Rada, R.E.: The use of low-molecular-weight heparins in outpatient oral surgery for patients receiving anticoagulation therapy. JADA 133:1083-1087, 2002
Kosyfaki P, Att W, Strub JR.: The dental patient on oral anticoagulant medication: a literature review. Journal of Oral Rehabilitation 38: 615–633, 2011
Larson BJ, Zumberg MS, Kitchens CS: A feasibility study of continuing dose-reduced warfarin for invasive procedures in patients with high thromboembolic risk. Chest 127:922-927, 2005
Levy JH, Key NS, Azran MS.: Novel oral anticoagulants; implications in the perioperative setting. Anesthesiology 113:726-745, 2010
Li C, Hirsh J, Xie C, Johnston MA, Eikelboom JW.: Reversal of the antiplatelκαι effects of aspirin and clopidogrel. J Thromb Haemost. 10:521-528, 2012 doi: 10.1111/j.1538-7836.2012.04641.x
Liew A, Eikelboom JW, O’Donnell M.: Randomized controlled trials of new oral anticoagulants for stroke prevention in atrial fibrillation. Curr Opin Cardiol 27:331–339, 2012
Lin L, Nizam SI, Fatahzadeh M. The impact of Prasugrel, a new antiplatelκαι agent, on dental care of patients. Quintessence Int. 44: 433-438, 2013 doi: 10.3290/ j.qi.a29183
Little JW, Miller CS, Henry RG, McIntosh BA.: Antithrombotic agents: implications in dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93:544-551, 2002
Lozano AC, Perez MG, Esteve CG. Dental management in patients with hemostasis alteration. J Clin Exp Dent. 3:e120-126, 2011 doi:10.4317/jced.3.e120
Madrid C, Sanz M.: What influence do anticoagulants have on oral implant therapy? A systematic review Clin Oral Implants Res. 4:96– 106, 2009
Maltais S, Perrault LP, Do QB.: Effect of clopidogrel on bleeding and transfusions after off-pump coronary artery bypass graft surgery: impact of discontinuation prior to surgery. Eur J Cardiothorac Surg 34: 127–131, 2008
Mehra P, Cottrell DA, Bestgen SC, Booth DF.: Management of heparin therapy in the high-risk, chronically anticoagulated, oral surgery patient: a review and a proposed nomogram. J Oral Maxillofac Surg. 58:198–202, 2000
Miyares MA, Davis K.: Newer oral anticoagulants: a review of laboratory monitoring options and reversal agents in the hemorrhagic patient. Am J Health-Syst Pharm. 69:1473-1484, 2012
Morimoto Y, Niwa H, Minematsu K.: Hemostatic management of tooth extractions in patients on oral antithrombotic therapy. J Oral Maxillofac Surg. 66:51-57, 2008
Moyer TP, O’Kane DJ, Baudhuin LM, Wiley CL, Fortini A και συν: Warfarin sensitivity genotyping: a review of the literature and summary of patient experience. Mayo Clin Proc 84:1079-1094, 2009
Neel S.: Essential warfarin knowledge. In: Gulseth M, ed.: Managing anticoagulation patients in the hospital. Bethesda,MD: American Society of Health-System Pharmacists; 133-175, 2007
Nutescu E, Chuatrisorn I, Hellenbart E.: Drug and dietary interactions of warfarin and novel oral anticoagulants: an update. J Thromb Thrombolysis 31:326–343, 2011
Nutescu EA.: Oral anticoagulant therapies: Balancing the risks. Am J Health-Syst Pharm. 70:Suppl1:S3-11, 2013
Patatanian E, Fugate SE.: Hemostatic mouthwashes in anticoagulated patients undergoing dental extraction. Annals of Pharmacotherapy 40:2205-2210, 2006
Pollack CV, Faha FF.: Managing bleeding in anticoagulated patients in the emergency care setting. J Emerg Med. 45:467-747, 2013 doi: 10.1016/ j.jemermed.2013.03.016
Pototski M, Amenabar JM.: Dental management of patients receiving anticoagulation or antiplatelκαι treatment. J Oral Sci 49;253-258, 2007
Rolfe S, Papadopoulos S, Cabral KP.: Controversies of anticoagulation reversal in life-threatening bleeds. J Pharm Pract 23:217-225, 2010
Samama CM, Bastien O, Forestier F, Denninger MH, Isetta C και συν: Antiplatelκαι agents in the perioperative period: expert recommendations of the French Society of Anesthesiology and Intensive Care (SFAR) 2001—summary statement. Can J Anaesth 49:S26- 35, 2002
Scully C, Wolff A.: Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 94:57–64, 2002
Small DS, Li YG, Ernest CS, April JH, Farid NA και συν: Integrated analysis of pharmacokinetic data across multiple clinical pharmacology studies of prasugrel, a new thienopyridine antiplatelκαι agent. J Clin Pharmacol 51: 321–332, 2011
Smout J, Stansby G.: Current practice in the use of antiplatelκαι agents in the peri-operative period by UK vascular surgeons. Ann R Coll Surg Engl 85:97-101, 2003
Spyropoulos AC, Turpie AG, Dunn AS, Spandorfer J, Douketis J και συν: Clinical outcomes with unfractionated heparin or low-molecular-weight heparin as bridging therapy in patients on long-term oral anticoagulants: the REGIMEN registry. J Thromb Haemost. 4:1246–1252, 2006
Stein PD, Schunemann HJ, Dalen JE, Gutterman D.: Antithrombotic therapy in patients with saphenous vein and internal mammary artery bypass grafts: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 600S–8S, 2004
Thiele T, Sümnig A, Hron G, Müller C, Althaus K, Schroeder HWS, Greinacher A. Platelκαι transfusion for reversal of dual antiplatelκαι therapy in patients requiring urgent surgery: a pilot study. J Thromb Haemost 10: 968–971, 2012
Tinmouth AH, Morrow BH, Cruickshank MK, Moore PM, Kovacs MJ.: Dalteparin as periprocedure anticoagulation for patients on warfarin and at high risk of thrombosis. Ann Pharmacother 35:669- 674, 2001
Todd DW, Roman A.: Outpatient use of low-molecular weight heparin in an anticoagulated patient requiring oral surgery: case report. J Oral Maxillofac Surg. 59:1090–1092, 2001
Van Ryn J, Stangier J, Haertter S, Liesenfeld KH, Wienen W και συν: Dabigatran etexilate—a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 103:1116–1127, 2010
Vilahur G, Choi BG, Zafar MU, Viles-Gonzalez J F, Vorchheimer DA και συν: Normalization of platelets reactivity in clopidogrel-treated subjects. J Thromb Haemost 5: 82–90, 2007
Wahl MJ, Howell J: Altering anticoagulation therapy: a survey of physicians. J Am Dent Assoc. 127:625–626, 1996
Wann LS, Curtis AB, Ellenbogen KA, Estes NA 3rd, Ezekowitz MD και συν: 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (update on Dabigatran): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123:1144–1150, 2011
Ward BB, Smith MH: Dentoalveolar procedures for the anticoagulated patient: literature recommendations versus current practice. J Oral Maxillofac Surg 65:1454-1460, 2007
Wildson F, Costa FWG, Rodrigues RR, de Sousa LHT, Francisco Carvalho SR και συν: Local hemostatic measures in anticoagulated patients undergoing oral surgery. A systematized literature review. ActaCir Bras.28:78-83, 2013
Zafar MU, Santos-Gallego C, Vorchheimer DA, Viles-Gonzalez JF, Elmariah S και συν: Platelκαι function normalization after a prasugrel loading-dose: time-dependent effect of platelκαι supplementation. J Thromb Haemost 11: 100–106, 2013
Department of Oral and Maxillofacial Surgery at Attikon Hospital, Medical School University of Athens, Greece. (Head: Professor E. Vairaktaris)
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 2, 65-76
SUMMARY: Nowadays the trend is not to interrupt anticoagulants or antiplatelet drugs for minor oral surgery; They can be safely performed when the INR is 2-4. The suturing of the wound and the use of hemostatic agents reduces the possibility of postoperative bleeding. In cases of major maxillofacial interventions, the shortest possible interruption of anticoagulants is recommended in order to avoid the risk of thrombosis. The same applies to aspirin, and in cases of dual therapy (aspirin and clopidogrel) discontinuation of clopidogrel and low dose of aspirin are recommended. In case of excessive bleeding, administration of clotting factors or fresh platelets is recommended when the patient is on anticoagulants or antiplatelets respectively. In this literature study we report the older and the newer anticoagulants (dabigatran and rivaroxaban) and antiplatelet drugs (prasugrel) as well as the surgical management of patients who take them.
KEY WORDS: oral and maxillofacial surgery; anticoagulants; antiplatelet drugs;
REFERENCES
Aframian DJ, Lalla RV, Peterson DE:.Management of dental patients taking common hemostasis- altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 103:1-11, 2007
Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G.: Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest: 141: e44S–88, 2012 doi: 10.1378/chest.11-2292
Aldridge E, Cunningbam LL.: Current Thoughts on Treatment of Patients Receiving Anticoagulation Therapy. J Oral Maxillofac Surg 68:2879-2887, 2010 Ardekian L, Gaspar R, Peled M, Brener B, Laufer D.: Does low-dose aspirin therapy complicate oral surgical procedures? JADA. 131:331- 335, 2000
Bajkin BV, Popovic SL, Selakovic SD.: Randomized, prospective trial comparing bridging therapy using low-molecularweight heparin with maintenance of oral anticoagulation during extraction of teeth. J Oral Maxillofac Surg. 67:990–995, 2009
Blinder D, Manor Y, Martinowitz U, Taicher S, Hashomer T.: Dental extractions in patients maintained on continued oral anticoagulant: Comparison of local hemostatic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:137-140, 1999
Brennan MT, Valerin MA, Noll JL, Napeñas JJ, Kent ML και συν: Aspirin use and post-operative bleeding from dental extractions. J Dent Res. 87:740-744, 2008 CAPRIE Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 348:1329-1339, 1996
Cardona-Tortajada F, Sainz-Gómez E, Figuerido-Garmendia J, de Robles-Adsuar AL, Morte-Casabó A. και συν: Dental extractions in patients on antiplatelκαι therapy. A study conducted by the Oral Health Department of the Navarre Health Service (Spain). Med Oral Patol Oral Cir Bucal. 14:e588-592, 2009 Castellone DD, Van Cott EM.: Laboratory monitoring of new anticoagulants. Am J Hematol 85:185-187, 2010 Danos EA. Apparent potentiation of warfarin activity by tetracycline. Clin Pharmacol 11:806-808, 1992
Dewan K, Bishop K, Muthukrishnan A.: Management of patients on warfarin by general dental practitioners in South West Wales: continuing the audit cycle. Br Dent J. 206:E8. discussion 214–215, 2009 doi: 10.1038/sj.bdj.2009.112
Douketis JD, Berger PB, Dunn AS, Jaffer AK, Spyropoulos AC, Becker RC, Ansell J. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: 299S–339S, 2008 doi: 10.1378/chest.08-0675
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK και συν: Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 141(Suppl 2):e326S-50S, 2012 doi: 10.1378/chest.11-2298
du Breuil AL, Umland EM.: Outpatient management of anticoagulation therapy. Am Fam Physician. 75:1031–1042, 2007
Dunn AS, Spyropoulos AC, Turpie AG. Bridging therapy in patients on long-term oral anticoagulants who require surgery: the Prospective Peri-operative Enoxaparin Cohort Trial (PROSPECT). J Thromb Haemost. 5:2211–2218, 2007
Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA και συν: ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 110: e340–437, 2004
Eisele R, Melzer N, Englert C, Bramlage P, Spannagl M.: Bridging with the Low molecular weight heparin certoparin in patients requiring temporary discontinuation of oral anticoagulation – the non-interventional, retrospective REMEMBER study. Thrombosis Research 130:788–792, 2012
Fijnheer R, Urbanus RT, Nieuwenhuis HK. [Withdrawing the use of acetylsalicyclic acid prior to an operation usually not necessary]. Ned Tijdschr Geneeskd 147:21-25, 2003
Firriolo JF, Hupp WS. Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol 113:431- 441, 2012
Garcia D, Libby E, Crowther MA. The new oral anticoagulants. Blood 115:15-20, 2010
Grines CL, Bonow RO, Casey DE Jr, Gardner TJ, Lockhart PB και συν: Prevention of premature discontinuation of dual antiplatelκαι therapy in patients with coronary artery stents. A science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation 115:813-818, 2007a
Grines CL, Bonow RO, Casey DE Jr, Gardner TJ, Lockhart PB και συν: Prevention of premature discontinuation of dual antiplatelκαι therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Catheter Cardiovasc Interv. 69:334-340, 2007b
Halfpenny W, Fraser JS, Adlam DM. Comparison of 2 hemostatic agents for the prevention of postextraction hemorrhage in patients on anticoagulants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 92:257-259, 2001
Harrington RA, Becker RC, Ezekowitz M, Meade TW, O’Connor CM και συν: Antithrombotic therapy for coronary artery disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 513S–48S, 2004
Harrison P, Robinson MS, Mackie IJ, Joseph J, McDonald SJ και συν: Performance of the platelκαι function analyser PFA-100 in testing abnormalities of primary haemostasis. Blood Coagul Fibrinolysis. 10:25-31, 1999 Heit JA. Perioperative Management of the Chronically Anticoagulated Patient. J Thromb Thrombolysis 12: 81-87, 2001
Hirsh J, Dalen J, Anderson DR, Poller L, Bussey H και συν: Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 119: suppl, 8S-21S, 2001
Hirsh J, Fuster V, Ansell J, Halperin JL.: American Heart Association/ American College of Cardiology Foundation guide to warfarin therapy. Circulation 107:1692–1711, 2003
Jeske AH, Suchko GD.: Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment. JADA. 134:1492–1497, 2003
Jiménez Y, Poveda R, Gavaldá C, Margaix M, Sarrión G.: An update on the management of anticoagulated patients programmed for dental extractions and surgery. Med Oral Patol Oral Cir Bucal. 13:E176-179, 2008
Johnson-Leong C, Rada, R.E.: The use of low-molecular-weight heparins in outpatient oral surgery for patients receiving anticoagulation therapy. JADA 133:1083-1087, 2002
Kosyfaki P, Att W, Strub JR.: The dental patient on oral anticoagulant medication: a literature review. Journal of Oral Rehabilitation 38: 615–633, 2011
Larson BJ, Zumberg MS, Kitchens CS: A feasibility study of continuing dose-reduced warfarin for invasive procedures in patients with high thromboembolic risk. Chest 127:922-927, 2005
Levy JH, Key NS, Azran MS.: Novel oral anticoagulants; implications in the perioperative setting. Anesthesiology 113:726-745, 2010
Li C, Hirsh J, Xie C, Johnston MA, Eikelboom JW.: Reversal of the antiplatelκαι effects of aspirin and clopidogrel. J Thromb Haemost. 10:521-528, 2012 doi: 10.1111/j.1538-7836.2012.04641.x
Liew A, Eikelboom JW, O’Donnell M.: Randomized controlled trials of new oral anticoagulants for stroke prevention in atrial fibrillation. Curr Opin Cardiol 27:331–339, 2012
Lin L, Nizam SI, Fatahzadeh M. The impact of Prasugrel, a new antiplatelκαι agent, on dental care of patients. Quintessence Int. 44: 433-438, 2013 doi: 10.3290/ j.qi.a29183
Little JW, Miller CS, Henry RG, McIntosh BA.: Antithrombotic agents: implications in dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93:544-551, 2002
Lozano AC, Perez MG, Esteve CG. Dental management in patients with hemostasis alteration. J Clin Exp Dent. 3:e120-126, 2011 doi:10.4317/jced.3.e120
Madrid C, Sanz M.: What influence do anticoagulants have on oral implant therapy? A systematic review Clin Oral Implants Res. 4:96– 106, 2009
Maltais S, Perrault LP, Do QB.: Effect of clopidogrel on bleeding and transfusions after off-pump coronary artery bypass graft surgery: impact of discontinuation prior to surgery. Eur J Cardiothorac Surg 34: 127–131, 2008
Mehra P, Cottrell DA, Bestgen SC, Booth DF.: Management of heparin therapy in the high-risk, chronically anticoagulated, oral surgery patient: a review and a proposed nomogram. J Oral Maxillofac Surg. 58:198–202, 2000
Miyares MA, Davis K.: Newer oral anticoagulants: a review of laboratory monitoring options and reversal agents in the hemorrhagic patient. Am J Health-Syst Pharm. 69:1473-1484, 2012
Morimoto Y, Niwa H, Minematsu K.: Hemostatic management of tooth extractions in patients on oral antithrombotic therapy. J Oral Maxillofac Surg. 66:51-57, 2008
Moyer TP, O’Kane DJ, Baudhuin LM, Wiley CL, Fortini A και συν: Warfarin sensitivity genotyping: a review of the literature and summary of patient experience. Mayo Clin Proc 84:1079-1094, 2009
Neel S.: Essential warfarin knowledge. In: Gulseth M, ed.: Managing anticoagulation patients in the hospital. Bethesda,MD: American Society of Health-System Pharmacists; 133-175, 2007
Nutescu E, Chuatrisorn I, Hellenbart E.: Drug and dietary interactions of warfarin and novel oral anticoagulants: an update. J Thromb Thrombolysis 31:326–343, 2011
Nutescu EA.: Oral anticoagulant therapies: Balancing the risks. Am J Health-Syst Pharm. 70:Suppl1:S3-11, 2013
Patatanian E, Fugate SE.: Hemostatic mouthwashes in anticoagulated patients undergoing dental extraction. Annals of Pharmacotherapy 40:2205-2210, 2006
Pollack CV, Faha FF.: Managing bleeding in anticoagulated patients in the emergency care setting. J Emerg Med. 45:467-747, 2013 doi: 10.1016/ j.jemermed.2013.03.016
Pototski M, Amenabar JM.: Dental management of patients receiving anticoagulation or antiplatelκαι treatment. J Oral Sci 49;253-258, 2007
Rolfe S, Papadopoulos S, Cabral KP.: Controversies of anticoagulation reversal in life-threatening bleeds. J Pharm Pract 23:217-225, 2010
Samama CM, Bastien O, Forestier F, Denninger MH, Isetta C και συν: Antiplatelκαι agents in the perioperative period: expert recommendations of the French Society of Anesthesiology and Intensive Care (SFAR) 2001—summary statement. Can J Anaesth 49:S26- 35, 2002
Scully C, Wolff A.: Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 94:57–64, 2002
Small DS, Li YG, Ernest CS, April JH, Farid NA και συν: Integrated analysis of pharmacokinetic data across multiple clinical pharmacology studies of prasugrel, a new thienopyridine antiplatelκαι agent. J Clin Pharmacol 51: 321–332, 2011
Smout J, Stansby G.: Current practice in the use of antiplatelκαι agents in the peri-operative period by UK vascular surgeons. Ann R Coll Surg Engl 85:97-101, 2003
Spyropoulos AC, Turpie AG, Dunn AS, Spandorfer J, Douketis J και συν: Clinical outcomes with unfractionated heparin or low-molecular-weight heparin as bridging therapy in patients on long-term oral anticoagulants: the REGIMEN registry. J Thromb Haemost. 4:1246–1252, 2006
Stein PD, Schunemann HJ, Dalen JE, Gutterman D.: Antithrombotic therapy in patients with saphenous vein and internal mammary artery bypass grafts: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 600S–8S, 2004
Thiele T, Sümnig A, Hron G, Müller C, Althaus K, Schroeder HWS, Greinacher A. Platelκαι transfusion for reversal of dual antiplatelκαι therapy in patients requiring urgent surgery: a pilot study. J Thromb Haemost 10: 968–971, 2012
Tinmouth AH, Morrow BH, Cruickshank MK, Moore PM, Kovacs MJ.: Dalteparin as periprocedure anticoagulation for patients on warfarin and at high risk of thrombosis. Ann Pharmacother 35:669- 674, 2001
Todd DW, Roman A.: Outpatient use of low-molecular weight heparin in an anticoagulated patient requiring oral surgery: case report. J Oral Maxillofac Surg. 59:1090–1092, 2001
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