In dental practice, anticoagulated patients represent a clinical challenge due to the delicate balance between bleeding control and preventing thromboembolic events. Modifying or adjusting anticoagulant therapy without a proper protocol can lead to severe complications. Therefore, understanding the importance of evidence-based decision-making is essential to ensure patient safety and the success of surgical treatments like dental implant placement.
Common Anticoagulants and Their Dental Implications
Common anticoagulants, such as SINTROM (acenocoumarol), warfarin (Coumadin), and antiplatelet agents like ADIRO 100 or 300 (aspirin), act in different ways to prevent clot formation. In a surgical context, these medications increase the risk of intraoperative and postoperative bleeding. However, discontinuing them without considering the patient’s thromboembolic risk can also be dangerous.
The key lies in individualizing the management of each case through a thorough evaluation and evidence-based protocols.
Initial Assessment: Key Factors
Before any surgical intervention in an anticoagulated patient, the following points should be considered:
- Type of anticoagulant: Identify whether the patient is under treatment with antiplatelet agents (e.g., ADIRO) or vitamin K antagonists (e.g., SINTROM or warfarin).
- Control of hematological values: Verify the INR (International Normalized Ratio) for patients on SINTROM or warfarin and ensure it is within the therapeutic range (usually between 2 and 3 for most indications).
- Thromboembolic risk: Determine if the patient is at high risk for thromboembolic complications, such as those with atrial fibrillation, deep vein thrombosis, or mechanical heart valves.
- Surgical bleeding risk: Evaluate the type of procedure. Implant placement is considered a moderate to high-risk surgical procedure depending on its extent.
At the end of this article you will find a practical table that can guide you into the right decision-making in anticoagulated patients requiring dental implant placement.
Intraoperative and Postoperative Measures
To minimize bleeding and promote proper healing, it is essential to apply local hemostatic measures during and after the procedure:
- Use of local hemostatic agents such as collagen sponges or tranexamic acid in gauze.
- Compression sutures to stabilize tissues.
- Mouth rinses with 5% tranexamic acid during the first postoperative days.
Conclusion
Proper management of anticoagulated patients during dental implant procedures not only ensures patient safety but also contributes to treatment success. Informed decision-making, based on clear protocols and tailored to the patient’s individual needs, is fundamental.
Providing dentists with practical tools like the decision-making table allows them to approach these cases with confidence and efficiency, ensuring high-quality care. If you would like to download the table presented in this article, you can access it through this link: Decision-Making Process for Anticoagulant Management
