Dental Extractions in Patients on Oral Anticoagulant

Objective: The purpose of this study was to evaluate the efficacy of fibrin glue as a local haemostatic agent following dental extraction in anticoagulated patients without interruption of their anticoagulant therapy. Methods:This study included 128 patients who were taking their anticoagulant medication at a therapeutic level and who were scheduled to undergo dental extractions. Postoperatively, local hemostasis was achieved as follows: group I included (166 extractions) with absorbable gelatin sponge and sutures, and group II (154 extractions) with fibrin glue, absorbable gelatin sponge and sutures. For each patient, indication for anticoagulation, international normalized ratio (INR) on the extraction day, the number of roots of the extracted teeth and complications were recorded and correlated. Results: There were 43 (33.6%) patients with prosthetic heart valves, 50 (39.1%) with atrial fibrillation, and 35 (27.3%) with previous thromboembolism. Forty nine (38.3%) patients were on low-intensity anticoagulation (INR, 1.0-2.0), 46 (35.9%) were on medium-intensity anticoagulation (INR, 2.1-3.0), and 33 (25.8%) were on high-intensity anticoagulation (INR, 3.1-5.0). Sixty patients (46.9%) patients had extraction of single-rooted teeth, 53 (41.4%0 had extraction of double-rooted teeth, and 15 (11.7%) had extraction of multi-rooted teeth. Of 128 patients 8 (6.2%) showed postoperative bleeding, 5 patients from group I and 3 patients from group II. No correlation was found between postoperative bleeding and INR or type of the extracted tooth. Conclusion: Fibrin glue can be safely used to reduce postoperative bleeding following dental extractions in patients maintained on their oral anticoagulant therapy.