Jc. Souto et al., ORAL-SURGERY IN ANTICOAGULATED PATIENTS WITHOUT REDUCING THE DOSE OF ORAL ANTICOAGULANT - A PROSPECTIVE RANDOMIZED STUDY, Journal of oral and maxillofacial surgery, 54(1), 1996, pp. 27-32
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.