Exodontic surgery in patients with coagulation disorders: a literature review
Authors
Liliana Ottria, Alberta Barlattani , Patrizio Bollero, Marco Gargari, Francesco Gianfreda, Alessandro D’Aurelio, Pasquale Giallaurito, Mirko Martelli
Abstract
BACKGROUND: Nowadays, patients with coagulation disorders, whether inherited or acquired, have grown significantly. Anticoagulant drugs (vitamin K antagonists, VKA, and the new oral anticoagulants, NAO) and Antiplatelet drugs are a powerful means for prophylaxis and treatment of thromboembolic events. In oral surgery, patients on anticoagulant or anti-aggregating therapies require special precautions because the use of these drugs, which act on the coagulation cascade or platelet aggregation, may result in prolonged bleeding following dental extraction. OBJECTIVE: As this is a controversial issue among physicians, dentists, and patients, this review aims to analyze, through a literature review, the risk of bleeding due to coagulopathy and to provide evidence-based principles of operative management to minimize this risk. METHODS: This Review was guided and reported according to PRISMA parameters. To conduct this review, searches were performed on the online search engines: PubMed, Google Scholar, and Scopus from January 1, 2014, to January 31, 2025. The search strategy included the following terms: dental extraction, anticoagulants, antiplatelet agents, and hemophilia. RESULTS: From the 124 articles obtained by entering search terms into various scientific databases, eliminating duplicates, and filtering them according to the inclusion criteria, we selected 27 articles for the final review. Cases of post extraction bleeding, including principles of prevention and treatment methods, were observed. DISCUSSION: The survey helped us understand the real risks that can occur during extractive surgery in patients with coagulation deficiency and the new protocols used in these cases. These findings showed that due to the variability of the medication taken, the comorbidities of the patient, and the procedure performed, it is impossible to create a single protocol. Therefore, the clinician must evaluate each case on a case-by-case basis and implement all the procedures known to them to stop bleeding.