Bleeding After Dental Extractions In Cardiac Patients On Anticoagulants Reduced By Protocol

Clinicians need a protocol to reduce the risk of substantial bleeding after dental extractions in cardiac patients who take anticoagulant medications. Findings in a study published in the current issue of the Journal of Oral Implantology reveal that the use of leukocyte- and platelet-rich fibrin biomaterial, a material commonly used in dentistry to improve healing and tissue regeneration, is a safe filling and haemostatic material after dental extractions.

Researchers assessed the use of the biomaterial in 50 heart patients who received oral anticoagulant therapy with warfarin after a mechanical valve substitution. It is not recommended to substitute anticoagulant therapy with heparin prior to minor surgery, even though the risk of postoperative bleeding could potentially be controlled.

Another method to control bleeding in these patients without suspending anticoagulant therapy is using platelet-rich plasma gel that is placed in post-extraction tooth sockets. However, even though the platelet concentrate method has proven to be successful, using it daily presents clinicians with a challenge given the therapy is very time-consuming to prepare and expensive. The alternative is platelet-rich fibrin, an easy and inexpensive to prepare alternative biomaterial. Its use has already been established and proved useful in daily dental practice as filling material for regeneration in order to place implants. By collecting blood without anticoagulant in tubes that is subsequently centrifuged, the blood divides into three layers, and creates a strong platelet-rich fibrin clot in the middle layer.

In their study, researchers treated 50 heart patients after anticoagulant therapy with leukocyte- and platelet-rich fibrin clots that were placed into the patient's post-extraction sockets. According to the findings, only two patients reported complications of bleeding with 10 patients reporting a mild bleeding, although all complications were resolved within a few hours following the oral surgery.

Furthermore, the researchers observed no painful events in any of the patients, with soft tissue healing quickly and complete wound closure within one week after oral surgery. They conclude that leukocyte- and platelet-rich fibrin provides an excellent alternative in heart patients on an anticoagulant regimen.