Resumo

GINER DIAZ, J. et al. Actualización de la cirugía oral en el paciente anticoagulado. Rev Esp Cirug Oral y Maxilofac [online]. 2003, vol.25, n.5, pp.294-303. ISSN 2173-9161.

Introduction: At this time, and only in the United Kingdom, about 300,000 people are taking oral anticoagulants. With an aging population in Europe and North America, and a greater worryness about teeth health, the number of oral anticoagulated patients requiring oral surgery is likely to increase. It is the aim of this study to give some guidelines in order to deal with the anticoagulated patient who requires oral surgery in its different ways. Matherial and methouds: The pertinent literature more recently published and indexed in Medline has been reviewed and compared. Besides, different surgery and clinics textbooks about the matter have been consulted. Results: Traditionally, anticoagulated patients requiring oral surgery were managed by either stopping their treatments or decreasing their anticoagulant levels before the surgical procedure. Common problems seen with this attitude were thrombi and vascular occlusion. Even, some cases of fatal emboli have been described. In the last years, some patients are converted from oral coagutherapy to parenteral standard heparin therapy before surgery. However, there is an important debate currently on whether this is required or even if it is safe. Recent publications show how teeth removal and other oral surgery procedures can be performed without modifying the anticoagulation regimens with INR (international normalized ratio) of 4 or less if special procedures for local haemostasis are used. No discernible differences in the postoperative outcome with regard to haemorrhage are found. Discussion: Even though further prospectives studies are needed in this area, it can be considered that the management of oral surgery on patients treated with anticoagulants should be influenced by different factors, such as type of surgical procedure, the INR value, other concomitant risk factors and a great deal of clinical judgement. Conclusions: We accept INR as an excellent method that allows the surgeon to know about the state of a patient´s anticoagulation. Different guideliness for these patients´ management are suggested. Any doubt should be referred to the haematologist or the physician prescriber.

Palavras-chave : Oral surgery; Anticoagulation; Haemostasis; Heparin.

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