ORAL-SURGERY IN ANTICOAGULATED PATIENTS WITHOUT REDUCING THE DOSE OF ORAL ANTICOAGULANT - A PROSPECTIVE RANDOMIZED STUDY

Purpose: This study assessed the risk associated with several schedule s of perioperative treatment with coumadin in anticoagulated patients who underwent oral surgery. Patients and Methods: A prospective, rando mized study compared bleeding complications with six perioperative sch edules in 92 patients chronically treated with acenocoumarol, In three of the perioperative schedules, the dose was reduced before surgery a nd calcium heparin was added, In the other three, oral anticoagulation was not modified and heparin was not used, The groups also differed r egarding the antifibrinolytic agents used and the postoperative measur es applied. Results: Those schedules in which the oral anticoagulation was not modified preoperatively and an antifibrinolytic agent was app lied locally both during and after surgery were not associated with a significantly higher odds ratio of bleeding complications than those i n whom oral anticoagulation was reduced and calcium heparin was added preoperatively. Conclusions: In orally anticoagulated patients who und ergo oral surgery, schedules that maintain the oral anticoagulant regi men and use local tranexamic acid as an antifibrinolytic agent postope ratively for 2 days are safe, simple, and less troublesome.