Management of Patients Taking Oral Antithrombotics

Abstract

Many patients receiving antithrombotic therapy (antiplatelet, anticoagulant drugs) visit our dental clinic. In the implant treatment of these patients, it is important to fully understand and manage antithrombotic therapy and antithrombotic agents. This article provides an overview of thrombosis, embolism, and antithrombotic therapy, and presents the 2020 version of clinical practice guidelines for tooth extraction in patients on antithrombotic therapy. The guidelines basically suggest that extraction should be performed under continuous antithrombotic medication and that local hemostasis should be ensured. However, this guideline was not developed for dental implant surgery. In dental implant surgery, it may be possible to use antithrombotic drugs under the same conditions as in normal tooth extraction, such as for placement of a few implants in a well-conditioned jaw crest or for minor procedures with a small area of mucoperiosteal elevation, where hemostatic measures can be performed as reliably as in normal tooth extraction. On the other hand, bone augmentation procedures are often accompanied by extensive mucoperiosteal detachment, which is a significant and extensive surgical invasion. In these cases, the extent of pressure hemostasis, the security of pressure, the fugue route of bleeding, and the presence of surrounding cellular tissue are all problematic, and careful and reliable hemostasis is essential. It is necessary to implement measures to address these issues and to work with medical facilities that can manage unexpected bleeding.