DRUG INTERACTIONS BETWEEN ANTICOAGULANT THERAPY AND INVASIVE DENTAL PROCEDURES

Sara Earar, Camelia Ana Grigore, Gabriel Valeriu Popa, Alina-Ramona Dimofte, Razvan Leata, Norina Consuela Forna, Doriana Agop Forna, Kamel Earar

Abstract

The management of anticoagulated patients in dentistry presents a significant challenge, requiring a balance between hemorrhagic and thromboembolic risks. Anticoagulants, including vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs), and low-molecular-weight heparins (LMWHs), increase bleeding risk during invasive dental procedures. Recent guidelines emphasize that maintaining anticoagulation with appropriate hemostatic measures is generally safer than treatment interruption, which may lead to thromboembolic complications. Preoperative assessment should consider the type of anticoagulant, the patient’s medical status, and the procedure’s risk level. VKAs require INR monitoring, while DOACs should be scheduled at their lowest plasma concentration. Advanced hemostatic agents (collagen, oxidized cellulose, tranexamic acid) and minimally invasive surgical techniques significantly reduce postoperative bleeding. Postoperative management includes patient education on bleeding control, avoiding NSAIDs, and close monitoring. Future research aims to develop predictable anticoagulants, advanced biomaterials, and AI-based risk assessment tools to improve patient safety. A multidisciplinary approach is essential for optimal care, ensuring successful dental treatment while minimizing complications. This review provides updated insights into best practices for managing anticoagulated patients in dentistry.

DOI : 10.62610/RJOR.2025.3.17.15