Anticoagulant therapy in patients undergoing dental interventions: a critical review of the literature and current perspectives

Patients treated with Oral Anticoagulant Therapy (TAO) represent an issue to the dentist, as an increasing number of people are using anticoagulant drugs for cardiovascular disease. The choice of an eventual suspension or continuation of anticoagulant therapy is important when considering an efficient management of the patient. Patients that are in anticoagulant therapy and requiring dental procedures sometimes represent therapeutic concerns especially as regards the suspension or less of anticoagulant treatment. At the moment there is no consensus among international experts of a possible discontinuation of therapy before invasive dental procedures. In this paper, the authors try to focus on this field through a critical review of the literature. Most of the studies do not suggest the reduction or discontinuation of anticoagulant treatment with Heparin or replacement before invasive oral surgical interventions. Based on the data of the literature, two rules must be adopted in clinical practice: a) Maintenance of anticoagulation related to the international normalized ratio (INR); b) Local application of anti-fibrinolytic agents to ensure a proper hemostatic process. Given the widespread use of anticoagulant drugs in cardiovascular disease, dentists are often called upon to address this therapy and, since there is no consensus on the management of these patients, the authors propose, after a thorough critical review of the literature, the implementation of a multi-phase protocol of surgical approach to be implemented with safety in daily clinical practice.