Journal of The Korean Dental Society of Anesthesiology (대한치과마취과학회지)

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지

Oral Surgery using Low-molecular-weight Heparin in the Anticoagulated Patients

항응고제 복용 환자에서 저분자량 헤파린을 사용한 구강 내 소수술

  • Hwang, Se-Young (Department of Advanced General Dentistry, Yonsei University College of dentistry) ;
  • Yun, Hee-Jung (Department of Advanced General Dentistry, Yonsei University College of dentistry) ;
  • Pang, Nan-Sim (Department of Advanced General Dentistry, Yonsei University College of dentistry) ;
  • Jung, Bock-Young (Department of Advanced General Dentistry, Yonsei University College of dentistry) ;
  • Kim, Kee-Deog (Department of Advanced General Dentistry, Yonsei University College of dentistry) ;
  • Kim, Hyung-Jun (Department of Oromaxillofacial Surgery, Yonsei University College of Dentistry) ;
  • Park, Wonse (Department of Advanced General Dentistry, Yonsei University College of dentistry)
  • 황세영 (연세대학교 치과대학병원 통합진료과) ;
  • 윤희정 (연세대학교 치과대학병원 통합진료과) ;
  • 방난심 (연세대학교 치과대학병원 통합진료과) ;
  • 정복영 (연세대학교 치과대학병원 통합진료과) ;
  • 김기덕 (연세대학교 치과대학병원 통합진료과) ;
  • 김형준 (연세대학교 치과대학병원 구강악안면외과) ;
  • 박원서 (연세대학교 치과대학병원 통합진료과)
  • Received : 2012.06.27
  • Accepted : 2012.07.02
  • Published : 2012.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Anticoagulation therapy with warfarin sodium is used to reduce the risk of thromboembolic events in patients with valvular heart disease, prosthetic heart valve, recurrent myocardiac infarction, etc. To keep anticoagulation state and minimize bleeding risk, patients with high risk of thromboembolism have been usually hospitalized for heparinization before oral surgery like extraction. However, this protocol requires time and high expense because of the long period of hospitalization and this is why low-molecular-weight heparin (LMWH) therapy is receiving attention in medical field as well as dentistry. LMWH has several advantages over unfractionated heparin (UFH) including predictable anticoagulant response which makes coagulation monitoring unnecessary in most patients and longer half-life than heparin which enables the patients to give themselves a subcutaneous injection once or twice daily. These advantages of LMWH make patients get oral surgery on an outpatient basis so that they can save time and cost. This case report introduces the use of LMWH in dental surgery and suggests proper use of LMWH. Though LMWH bridging therapy is widely used most of the previous studies are observational studies. Therefore randomized controlled trials are necessary to evaluate the safety and efficacy of LMWH bridging therapy.

Keywords

References

  1. Carlos Madrid, Mariano Sanz: What influence do anticoagulants have on oral implant therapy? A systematic review. Clin Oral Impl Res 2009; 20(4): 96-106. https://doi.org/10.1111/j.1600-0501.2009.01770.x
  2. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al: Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133(6 Suppl): 381S-453S. https://doi.org/10.1378/chest.08-0656
  3. Aframian DJ, Lalla RV, Peterson DE: Management of dental patients taking common hemostasis-altering medications. Oral Surgery Oral Medicine Oral Radiology and Endodontics 2007; 103(Suppl.): S45 eI-eII. https://doi.org/10.1016/j.tripleo.2006.08.026
  4. O'Reilly RA, Aggeler PM: Determinants of the response to oral anticoagulant drug in man. Pharmacological Reviews 1970; 22: 35-96.
  5. White RH, McKittrick T, Hutchinson R, Twitchell H: Temporary discontinuation of warfarin therapy: Changes in the international normalized ratio. Ann Intrn Med 1995; 122(1): 40-2. https://doi.org/10.7326/0003-4819-122-1-199501010-00006
  6. Johnson-Leong C, Rada RE.: The use of low-molecularweight heparins in outpatient oral surgery for patients receiving anticoagulation therapy. JADA 2002; 133(8): 1083-7.
  7. Jaffer AK, Ahmed M, Brotman DJ, Bragg L, Seshadri N, Qadeer MA, et al: Low-molecular-weight heparins as periprocedural anticoagulation for patients on long-term warfarin therapy: A standardized bridging therapy protocol. Journal of thrombosis and thrombolysis 2005; 20(1): 11-6. https://doi.org/10.1007/s11239-005-3120-9
  8. Devani P, Lavery KM, Howell CJ: Dental extractions in patients on warfarin: is alteration of anticoagulant regime necessary? Br J Oral and Maxillofac Surg 1998; 36: 107-11. https://doi.org/10.1016/S0266-4356(98)90177-2
  9. Douketis JD, Johnson JA, Turpie AG: Low-molecularweight heparin as bridging anticoagulation during interruption of warfarin: Assessment of a standardized periprocedural anticoagulation regimen. Arch Intern Med 2004; 164(12): 1319-26. https://doi.org/10.1001/archinte.164.12.1319
  10. Kovacs MJ, Kearon C, Rodger M, Anderson DR, Turpie AG, Bates SM, et al: Single-arm study of bridging therapy with low-molecular-weight heparin for patients at risk of arterial embolism who require temporary interruption of warfarin. Circulation 2004; 110(12): 1658-63. https://doi.org/10.1161/01.CIR.0000142859.77578.C9
  11. Bristol-Myers Squibb Co. Coumadin(Warfarin Sodium) Talets, package insert. Princeton, NJ, Bristol-Myers Squibb Co, 2002
  12. Aventis Phamaceuticals Products Inc. Lovenox (Enoxaparin Sodium) Injection, package insert. Bridgewater, NJ, Aventis Phamaceuticals Products Inc, 2001
  13. Bhatt V, Moss C: Antibiotics and anticoagulants: Beware when prescribing concurrently. Br J Oral and Maxillofac Surg 2001; 39: 163.
  14. Galla JM FB: Outpatient anticoagulation protocol for mechanical valve recipients undergoing non-cardiac surgery [abstract]. J Am Coll Cardiol 2000; 135: 531A.
  15. Lev-Ran O, Kramer A, Gurevitch J, Shapira I, Mohr R: Low-molecular-weight heparin for prosthetic heart valves: Treatment failure. Ann Thorac Surg 2000; 69(1): 264-265; Discussion 265-6. https://doi.org/10.1016/S0003-4975(99)00874-7
  16. Spandorfer J: The management of anticoagulation before and after procedures. Medical Clinics of North America 2001; 85(5): 1109-16. https://doi.org/10.1016/S0025-7125(05)70366-7
  17. System UH: Home LMWH bridge therapy in cardiac valve replacement: Safe, effective and cost saving. Formulary 2000; 35: 990-1.