Management of Patients Receiving Anticoagulant and Antiplatelet Therapy in Oral Surgery: Current Clinical Approaches

Öz

Management of oral surgical procedures in patients receiving anticoagulant and antiplatelet therapy requires careful balancing between procedure-related bleeding risk and thromboembolic complications that may arise from interruption of antithrombotic treatment. Current practice is based more on individualized risk assessment than on routine discontinuation of therapy. Current evidence suggests that many simple and limited dental procedures can be performed safely without discontinuing antithrombotic therapy and that most bleeding events can be controlled with appropriate local hemostatic measures. Although there are some differences among vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs), and antiplatelet agents in terms of clinical management, the common principle is that routine interruption of therapy is usually unnecessary. Safe oral surgical management depends on individualized risk assessment, appropriate drug-specific decision-making, effective local hemostatic strategies, and planned postoperative follow-up. This review aims to evaluate preoperative risk assessment, drug-specific clinical management principles, local hemostatic approaches, and postoperative follow-up strategies in patients receiving anticoagulant and antiplatelet therapy in light of current literature.

Anahtar Kelimeler

• Anticoagulants
• Platelet Aggregation Inhibitors
• Oral Surgical Procedures
• Hemostasis, Surgical
• Postoperative Hemorrhage

Oral Cerrahide Antikoagülan ve Antiagregan Tedavi Alan Hastaların Yönetimi: Güncel Klinik Yaklaşımlar

Öz

Antikoagülan ve antiagregan ilaç kullanan hastalarda oral cerrahi girişimlerin yönetimi, cerrahiye bağlı kanama riski ile antitrombotik tedavinin kesilmesine bağlı gelişebilecek tromboembolik komplikasyonlar arasında dikkatli bir denge kurulmasını gerektirmektedir. Güncel yaklaşım, antitrombotik tedavinin rutin olarak kesilmesinden çok bireyselleştirilmiş risk değerlendirmesine dayanmaktadır. Mevcut veriler, basit ve sınırlı dental işlemlerin birçok olguda antitrombotik tedavi kesilmeden güvenli şekilde gerçekleştirilebildiğini ve gelişen kanamaların çoğu durumda lokal hemostatik önlemlerle kontrol altına alınabildiğini göstermektedir. Vitamin K antagonistleri (VKA), direkt oral antikoagülanlar (DOAC) ve antiagregan ilaçlar arasında klinik yönetim açısından bazı farklılıklar bulunmakla birlikte, ortak yaklaşım antitrombotik tedavinin rutin olarak kesilmemesi yönündedir. Güvenli oral cerrahi yönetimi; bireyselleştirilmiş risk değerlendirmesi, uygun ilaç yönetimi, etkili lokal hemostaz ve planlı postoperatif izlemin birlikte uygulanmasına dayanmaktadır. Bu derleme, antikoagülan ve antiagregan tedavi alan hastalarda oral cerrahi öncesi risk değerlendirmesini, ilaç grubuna göre klinik yönetim ilkelerini, lokal hemostaz yaklaşımlarını ve postoperatif izlem stratejilerini güncel literatür ışığında değerlendirmeyi hedeflemektedir.

Anahtar Kelimeler

• Antikoagülanlar
• Trombosit Agregasyon İnhibitörleri
• Oral Cerrahi İşlemleri
• Kanamanın Durması, Cerrahi
• Postoperatif Kanama

Kaynakça

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