Background and objectives: In today’s ageing societies dentist commonly treat patients with chronic medical conditions requiring regular drug administration. When talking about dental surgical treatment, there is a long and vivid history of discussions, whether or not oral anticoagulation with coumarines needs to be withdrawn or substituted for low-molecular-weight-heparines (LMWH). We report our 6 years experiences of post operative bleeding in daily routine.
Methods: Retrospective analysis of post operative bleeding incidents after dentoalveolar surgery from years 2007 to 2012.
Results: 405 patients (250 male, age 11.7–96.6) were treated due to bleeding complications. 71% of initial procedures were performed alio loco. 90% of bleeding incidents occured within 5 days postoperatively. Most frequent general medical conditions were atrial fibrillation (37%), vascular endoprosthesis (26%), thrombembolic events (25%). Mean INR was 2.7. 40% of bleeding incidents occured in patients on LMWH bridging regime and paused coumarines. Prolonged bleeding was more frequent in patients with cirrhosis and dialysis. Haemodynamic relevant bleeding and transfusions were necessary in 15 patients.
Conclusion: In our collective population we can describe twice the number of postoperative bleeding incidents on bridging with LMWH as on unchanged coumarines (40% vs. 19.7%). Results support that alteration of standing coumarine or any other anticoagulation regimen, especially bridging to LWMH, is not needed nor recommendable for dental-surgical treatments in regional anaesthesia.
Key words: oral anticoagulation therapy; bleeding risk; thrombembolic risk; bridging in dentoalveolar surgery