Stop the nonsense not the anticoagulants: a matter of life and death

Abstract

Many dental patients have medical problems that require the administration of oral anticoagulants to prevent catastrophic or life-threatening thromboembolic events. Examples include patients with medical conditions such as atrial fibrillation, mechanical heart valves, recent pulmonary embolism, stroke, deep vein thrombosis, anticardiolipin syndrome and coronary artery disease. The oral anticoagulant used most commonly in these instances is Coumadin. Stopping the administration of Coumadin to perform routine dental procedures can be life threatening. Many physicians and dentists believe these patients may not have routine dental procedures, including cleanings and uncomplicated extractions, while on Coumadin for fear of serious postoperative bleeding. No scientific evidence exists to support removing these patients from Coumadin to perform routine dental procedures and uncomplicated extractions, provided the patient's level of anticoagulation is within therapeutic range. Science clearly indicates that in the case of routine dental work, including uncomplicated extractions, the risk of a patient on Coumadin having a life-threatening thromboembolic event if the anticoagulant therapy is stopped is three- to five-times greater than the risk of the patient having postoperative bleeding that cannot be controlled with local measures.