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Clinical Guidelines
Preoperative Management
January 2016
Oral Health & Diagnostic Sciences
Clinical Guidelines
consultation with physician) reduction of anticoagulation using partial
withdrawal protocol to INR 3.0 or less. There is rarely an indication for
complete elimination of anticoagulation.
Discontinuation of factor Xa inhibitor approximately two days before
elective surgery without the need for bridging anticoagulation and
resumption of the medication 6 to 10 hours after surgery with attainment of
adequate hemostasis have been suggested in the medical literature. A
consult with the treating physician is advised.
Postoperative Management
Oral Manifestations
Spontaneous gingival bleeding, especially in those with thrombocytopenia
Petechiae, ecchymoses, jaundice, pallor and ulcers of the oral tissues
Hemarthrosis of TMJ (rare)
With the following co-morbidities,
o Chronic liver disease enlargement of parotid glands
o Leukemia gingival hyperplasia
o Neoplastic disease radiographic osseous lesions, oral ulcers and
tumors, drifting and loosening of teeth, paresthesias (e.g. burning
tongue, lip numbness)
References
1. Little, Falace. The dental management of the medically compromised patient. 8 edition.
Mosby, 2008.
2. Rhodus, Miller. Clinicians guide: the medically complex dental patients. Third edition B.C.
Decker, 2008
3. Schulman S, Crowther MA (2012) How I treat with anticoagulants in 2012: new and old
anticoagulants, and when and how to switch. Blood 119: 3016-3023.
4. Turpie AG, Kreutz R, Llau J, Norrving B, Haas S (2012) Management consensus
guidance for the use of rivaroxaban--an oral, direct factor Xa inhibitor. Thromb Haemost
108: 876-886.
5. Hong CH, Islam I(2013) Anti-Thrombotic Therapy: Implications for Invasive Outpatient
Procedures in Dentistry. Blood Disorders Transf 2013, 4:6
January 2016