Oral and maxillofacial surgery in patients on anticoagulant/antiplatelet therapy- a review

Objective: To review the antiplatelet and anticoagulant drugs currently used and to highlight the management of patients with anticoagulant therapy undergoing minor and invasive oral and maxillofacial surgical procedures. Materials and methods: A systematic review of the literature on PubMed, Science Direct, Springer regarding anticoagulation therapy during oral surgery procedures from 1996 to 2020 was done. Data on the indications for anticoagulant treatment, the regimen of anticoagulation, bridging used, the procedure done, local hemostatic agents used, thromboembolic outcome, follow-up period and bleeding characteristics were collected. Results: The thromboembolic risk due to withdrawal of oral anticoagulants outweighs the risk of bleeding and thus in majority of minor oral surgical procedures discontinuing the regimen is not recommended. Most of the bleeding complications can be controlled with local hemostatic measures. Major invasive oral and maxillofacial procedures with high risk patients warrants cessation of anticoagulant drugs with bridging therapy. The novel oral anticoagulants and newer antiplatelet agents has definite advantages over older main stay drugs especially warfarin and aspirin.