Anticoagulant therapy: challenges and approaches in managing bleeding risks during dental procedures

Abstract

 Anticoagulant therapy is essential for managing thromboembolic disorders but presents challenges in dental procedures due to bleeding risks. Agents such as vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs), and low-molecular-weight heparins (LMWHs) require careful perioperative management. Local hemostatic measures and interdisciplinary collaboration are key in ensuring patient safety. Materials and Methods: A systematic review followed PRISMA guidelines, analyzing studies from 1989 to 2024. Searches in PubMed, Scopus, and Web of Science used keywords like “anticoagulant” AND “dentistry.” Inclusion criteria focused on randomized clinical trials involving human subjects, while non-English studies and reviews were excluded. The ROBINS-I tool assessed bias across selected studies.

Results: of 623 articles screened, 25 met the eligibility criteria. Findings demonstrate that local hemostatic agents, including tranexamic acid and platelet-rich fibrin, effectively control bleeding without discontinuing anticoagulants. DOACs showed safety comparable to VKAs. Variability in dentists’ knowledge emphasizes the need for education. Innovative approaches, like biomaterials and plant-based therapies, were promising.

In conclusion, local hemostatic measures and personalized care enable safe dental procedures in anticoagulated patients, minimizing thromboembolic risks. Continued education and research are essential for improving protocols and outcomes.