From The Journal of Oral and Maxillofacial Surgery

[Guest]

PURPOSE: The aim of this prospective study was to compare the effectiveness of a 4.8% tranexamic acid mouthwash versus an autologous fibrin glue preparation to control hemostasis in patients therapeutically anticoagulated with warfarin who required dental extractions without interruption of their treatment. PATIENTS AND METHODS: The 49 patients who underwent 152 dental extractions were randomly allocated to 2 groups: Group A were required to rinse with 10 mL of a 4.8% tranexamic acid solution 4 times a day for 7 days postoperatively. Group B received autologous fibrin glue intraoperatively. The international normalized ratio was measured on the day of the procedure. All procedures were performed on an ambulatory basis by the same surgeon. RESULTS: Of the 49 patients, 2 presented with postoperative bleeding (4%). Both patients were from the autologous fibrin glue group and were found to have grossly elevated international normalized ratios on the day of the bleeding that was unaccounted for. CONCLUSIONS: This study supports the consensus that dental extractions can be performed without modification of oral anticoagulant treatment. Local hemostasis with an absorbable oxidized cellulose mesh, tranexamic acid, and sutures is the more cost efficient of the 2 methods compared; however, autologous fibrin glue has an important role in patients unable to use a mouthwash effectively.

Reference: J Oral Maxillofac Surg. 2003 Dec;61(12):1432-5.

Tranexamic acid mouthwash versus autologous fibrin glue in patients taking warfarin undergoing dental extractions: a randomized prospective clinical study.

Carter G, Goss A, Lloyd J, Tocchetti R. Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, University of Adelaide, Australia.

A Link is not practical because it requires a subscription to get in.

 

[Guest]

And Another study from the same journal

And Another study from the same journal

PURPOSE: Our goal was to evaluate the local hemostatic effect of n-butyl-2-cyanoacrylate (Histoacryl; B. Braun, Melsungen, Germany) glue in warfarin-treated patients who undergo outpatient oral surgery without a change in their level of anticoagulation. MATERIALS AND METHODS: Thirty consecutive warfarin-treated patients randomly assigned to study and control groups and 10 patients who had never been on anticoagulant therapy serving as the negative control group were included in this trial. Before multiple teeth extractions, all patients had a prothrombin time and the international normalized ratio (INR) determined. To gain hemostasis and primary closure, gelatin sponge and multiple interrupted resorbable sutures were used in the control and negative control groups, and Histoacryl glue and the minimal number of interrupted resorbable sutures were used in the study group. Postoperatively, patients were to contact the oral surgeon if abnormal bleeding occurred. Patients who did not have postoperative bleeding were seen on the 10th postoperative day. Data were collected, and statistical differences in age and gender distributions, number of teeth extracted, INR levels, and bleeding that required treatment were analyzed with the Mantel-Haenzel test. Statistical significance was defined as a value of P <.05. RESULTS: Local hemostasis was obtained immediately in study patients and only after 10 to 20 minutes in the control and negative control patients. In relation to bleeding complications, there were no cases of postoperative bleeding requiring treatment in both the negative control patients and study patients. In the control patients, 5 cases had postoperative spontaneous bleeding that required treatment. This difference was statistically significant. No patient had wound infection and the healing process appeared to be normal. CONCLUSION: Multiple extractions can be performed in patients taking oral anticoagulant therapy without a change in their level of anticoagulation provided an efficient local hemostatic measure is instituted. And, in this regard, Histoacryl glue, used as a topical adhesive over approximated wound edges, is an effective and easily applicable local hemostatic for oral surgery in such patients.

References:J Oral Maxillofac Surg. 2003 Dec;61(12):1405-9.

Hemostatic effect of n-butyl-2-cyanoacrylate (histoacryl) glue in warfarin-treated patients undergoing oral surgery.

Al-Belasy FA, Amer MZ.
Oral Surgery Department, Faculty of Dentistry, Mansoura University, Egypt.


The only conclusion must be that and dentist, oral surgeon or physician having a patient discontinue warfarin is not relying on the evidence-based medicine.

There can be little doubt that, in the event of someone having an adverse event resulting in a lawsuit, the doctor who ordered the warfarin stopped would face a parade of experts testifying against him/her in court.

 

[catwoman]

Al:

Thanks for posting both of these. Who did the studies and where? Also, publication date?

 

[LUVMyBirman]

Whoa!

Whoa!

Thanks Al. Great information. Is there a way to link the original article...would be apprecaited.

Love to have it on file, TY again.

 

[Guest]

The references are now part of the original articles.

 

[bvdr]

Thanks Al. I think I'll just file these away for some written reference material should the need ever arise.

 

[Blanche]

Al:
Many thanks for posting these two articles and the third one on a separate thread. They have been sent to our dentist today. I'm also sending copies to Al's internist who has about 30 patients on Coumadin, and to Al's Cardiologist.

For a long time, I have been thinking about putting together a bibliography on the topic of anticoagulation therapy and dental work. I do have quite a few evidence-based articles and articles from authorities, such as dental associations and large dental and maxillofacial surgeons practices. I would make this bibliography available to interested persons as well as medical and dental practitioners. Our dentist has already volunteered to share such a bibliography with his colleagues, especially those who are still requiring patients to discontinue anticoagulation.

My attorney tells me that the only way the dangerous practice of discontinuing anticoagulation will end will come after a death and a large damage settlement. He may be right. I, however, believe that education, in the form of evidence-based research, can be mightier than the lawsuit.

I would appreciate any advice, suggestions, or materials that you might wish to share with me.

Blanche

 

[Guest]

Blanche,

If the bibliography is in Microsoft Word without much fancy formatting, it should convert easily to HTML using Front Page. If you would like to send it to me as an e-mail attachment, I'll see if I can get it on my website. Of course I will give you as much credit for it as you would like. (Some people do not like seeing first and last name oin the internet).

There is at least one pharmacy journal that has a column called Basic Bibliographies so be assured that this is a valid technique.

 

[Blanche]

Al:
Thank you for the kind offer. I'll send you the bibliography, properly formated, probably in late January. I appreciate your support.
Blanche