We devised a treatment protocol for simple tooth extraction that conforms to the “Guidelines for management of anticoagulant and antiplatelet therapy in cardiovascular disease (JCS2004)”. Using this protocol, 1,020 simple dental extractions were performed in patients on antithrombotic therapy (patient group) and in control patients (control group).
We statistically analyzed bleeding after tooth extraction following complete hemostasis (postoperative bleeding), difficulty stopping bleeding after tooth extraction (hemostatic difficulty), background factors, contents of hemostasis, antithrombotic medications, oral surgery specialist qualification of the operator, and PT-INR.In the patient group, 56 cases with hemostatic difficulty were observed (14.7%) and postoperative bleeding (3.1%) after extraction occurred in 12 of the 382 cases. In the control group, there were 12 cases with hemostatic difficulty (1.9%) and one with postoperative bleeding (0.2%) among the 638 undergoing extraction. Hemostatic difficulty and postoperative bleeding requiring serious systemic hemostatic intervention was not observed in any of the cases undergoing extraction. Factors related to hemostasis difficulties were local inflammatory and anti-platelet therapy and warfarin therapy. Factors associated with postoperative bleeding were oral surgery specialist qualification and warfarin therapy.
In this study, tooth extraction was performed employing our protocol which is based on compressive hemostasis. Tooth extraction can be safely carried out during antithrombotic therapy with appropriate local hemostasis. Furthermore, hemostasis was possible with a local hemostatic method in all cases of the patient group and the control group.
