Our Summary

This research paper is the second part of a study on how to manage patients who are on blood-thinning medications before, during, and after dental procedures and oral surgery. The paper talks about the different factors that are taken into account when creating a plan for these patients, which is done in collaboration with dentists and other doctors. The study also looks at how to assess the risks of blood clots and blockages in blood vessels, as well as how to evaluate the risks of bleeding for each patient and specific procedures. The paper gives particular focus to the risks of bleeding during procedures when patients are sedated or put under general anesthesia in a dental office setting.

FAQs

  1. What factors are considered when developing a perioperative management plan for patients on oral antithrombotic therapy?
  2. How are thrombotic and thromboembolic risks assessed in patients undergoing oral surgery?
  3. What are the specific bleeding risks associated with procedures that involve sedation and general anesthesia within the office-based dental environment?

Doctor’s Tip

A helpful tip a doctor might tell a patient about oral surgery is to follow all pre-operative instructions provided by the oral surgeon, including any fasting guidelines and medication instructions. It is important to inform the oral surgeon about any medications you are currently taking, especially blood thinners, as they may need to be adjusted before the surgery. Additionally, make sure to follow all post-operative care instructions to ensure proper healing and minimize the risk of complications.

Suitable For

Patients who are typically recommended oral surgery include those who are on oral antithrombotic therapy, such as antiplatelet and anticoagulant medications. These patients may require oral surgery for a variety of reasons, including tooth extraction, dental implants, or other oral procedures. It is important to carefully assess the patient’s bleeding risks and consult with their managing physician to develop a perioperative management plan that minimizes the risk of bleeding complications during and after the surgery. Special attention should be given to patients who may require sedation or general anesthesia, as these procedures can increase the risk of bleeding in patients on antithrombotic therapy.

Timeline

Before oral surgery:

  1. Patient consults with dentist or oral surgeon to discuss treatment options and potential risks.
  2. Patient may undergo pre-operative testing, such as blood work or imaging studies.
  3. Patient may be instructed to stop taking certain medications, such as blood thinners, prior to surgery.
  4. Patient receives pre-operative instructions, such as fasting guidelines and medication instructions.

After oral surgery:

  1. Patient undergoes the oral surgery procedure under local anesthesia, sedation, or general anesthesia.
  2. Patient is monitored closely during and after the procedure for any complications.
  3. Patient may experience pain and swelling in the days following surgery and is prescribed pain medication and instructed on proper post-operative care.
  4. Patient follows up with the dentist or oral surgeon for post-operative appointments to monitor healing and address any concerns.

What to Ask Your Doctor

  1. What specific oral antithrombotic medication(s) am I currently taking?
  2. Should I continue taking my oral antithrombotic medication(s) leading up to the surgery?
  3. Are there any specific precautions I should take before the surgery, such as avoiding certain foods or medications?
  4. How will my oral antithrombotic medication(s) affect the surgery and the healing process afterwards?
  5. What is the risk of bleeding during and after the surgery while on oral antithrombotic medication(s)?
  6. Are there any alternative treatment options or adjustments to my medication regimen that could minimize the risk of bleeding during the surgery?
  7. What should I do if I experience excessive bleeding or other complications following the surgery?
  8. How soon after the surgery can I resume taking my oral antithrombotic medication(s)?
  9. What follow-up care or monitoring will be necessary after the surgery, considering my oral antithrombotic medication(s)?

Reference

Authors: Statman BJ. Journal: Anesth Prog. 2023 Mar 1;70(1):37-48. doi: 10.2344/anpr-70-01-06. PMID: 36995961