Stop the nonsense but not the anticoagulants!

"Stop the nonsense to stop taking anticoagulants!" Under this headline, some years ago articles were published in international medical journals. It was pointed out in these publications that an interruption of the anticoagulation therapy was not necessary for dental surgery.

These statements were concluded  from results of globally conducted studies, which were designed to find out which risks existed in continuing or interrupting anticoagulation therapy. The analysis showed that an interruption of the anticoagulation therapy is not always necessary for dental surgery. Continuing the therapy may increase the bleeding risk, but these bleedings can usually be easily stopped with local measures.

Additionally, it was stated that the interruption of the anticoagulation therapy is not a warranty that the risk of a post-surgical bleeding, which requires an intervention, is not existing, since serious bleedings can also occur in non anticoagulated patients.

The "North West Medicines Information Centre" in Liverpool, publishes constantly updated guidelines since 2001. In these guideline, practical advice is given also for patients on anticoagulation therapy. If a dental surgery is necessary, the INR value should be determined on Monday. If the value is higher than 4, no surgery should  takes place. Ideally, the surgery should be conducted on Tuesday morning. This would allow the treatment of a possible major bleeding during the working week. Patients with mechanical heart valves are risk patients. Therefore attention has to be paid to the prophylaxis of an endocarditis. If pain should arise, Paracetamol is the pain killer of choice.

An Australian physician described the discussion around the pros and cons with the words: "interrupting the anticoagulation therapy for dental surgery might lower the risk for bleedings, but increases the risk for thromboembolic events. A stroke is a disastrous event, in contrast to this a serious bleeding after pulling a tooth is always the lesser of the two evils.

Christian Schaefer, Chairman of ISMAAP, Geneva (July, 2008)