Oral Surgery Protocol to Control Bleeding for Heart Patients

Cardiac patients who take anticoagulant medications and need a tooth extraction face an increased risk of bleeding that must be addressed by the treating clinician. Therefore, a protocol for heart patients is needed that will avoid significant bleeding after dental extractions without suspending anticoagulant therapy. A study reported in the Journal of Oral Implantology evaluated the use of leukocyte- and platelet-rich fibrin biomaterial. This material is commonly used in dentistry to improve healing and tissue regeneration. It was tested as a safe filling and hemostatic material after dental extractions in 50 heart patients undergoing oral anticoagulant therapy. These heart patients had mechanical valve substitutions, and then were placed on anticoagulant oral therapy with warfarin. It is not recommended that the anticoagulant be suspended and replaced with heparin before a mi­nor surgery, although this substitution may control the risk of postoperative bleeding. One method of controlling bleed­ing without suspending the anticoagulant is the use of platelet-rich plasma gel placed in postextraction tooth sockets. Although this protocol has been successful, there are barriers to its daily use. The platelet concentrates are expensive and take a long time to prepare. Platelet-rich fibrin offers an alternative biomaterial that is simple and inexpensive to prepare. Blood is collected in tubes without anticoagulant and centrifuged. It divides into 3 layers, creating a strong platelet-rich fibrin clot in the middle layer. Plate­let-rich fibrin has proven useful in daily dental practice as filling material for regeneration in order to place implants. In this study, 50 heart patients following an anticoagulant therapy were treated with leukocyte- and platelet-rich fibrin clots placed into postextraction sockets. Compli­cations of bleeding were reported in only 2 of these patients, and 10 had mild bleeding. All complications were re­solved within a few hours after the oral surgery. Add­i­tionally, the study reported no pain­ful events, quick healing of soft tissue, and complete wound closure within one week after oral surgery. Leukocyte- and platelet-rich fibrin offers an excellent option for use in heart patients on an anticoagulant regimen.

(Source: Sammar­tino G et al. “Prevention of Hemor­rhagic Com­p­li­­cations After Dental Extrac­tions Into Open Heart Surgery Pa­tients Under Anticoagulant Ther­apy: The Use of Leukocyte- and Platelet-Rich Fibrin,” Journal of Oral Im­plan­tol­ogy. 2011, Volume 37, Number 6, pages 681-690.)