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| Author and year of publication | Design | Number of participants | Age (mean (range) or mean ± SD or mean ± SD (range)) | Indications for anticoagulant treatment | Exclusion criteria | Regimen of anticoagulation | Bridging used | Procedure | Local hemostatic agents used | Target INR before the procedure | Preoperative INR (mean (range) or mean ± SD) | Maximum follow-up period |
|
| Campbell et al., 2000 [31] | CCT | 60 | Not mentioned in the study | Not mentioned in the study | Not mentioned in the study | Experimental (n = 12): warfarin continued
Control (n = 13): warfarin stopped 72 to 96 hours before the procedure
Baseline group (n = 35): no anticoagulation used | None | Dental extractions, quadrant alveoloplasty, frenectomy | Not mentioned in the study | Not mentioned in the study | Experimental: 2 (1.2–2.9)
Control: 2 (1.1–3)
Baseline group: not done | 1 day |
|
| Evans et al., 2002 [27] | RCT | 109 | Experimental: 67 (36–92)
Control: 66 (30–93) | Not mentioned in the study | INR > 4 on the day of operation; liver disease; coagulopathies | Experimental (n = 57): warfarin continued
Control (n = 52): warfarin stopped 2 days before the procedure | None | Dental extractions and mucoperiosteal flap sometimes raised | Oxycellulose with sutures | Experimental: INR less than 4
Control: INR less than 2 | Experimental: 2.5 (1.2–4.7)
Control: 1.6 (1.2–2.3) | 7 days |
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| Erden et al., 2015 [32] | CCT | 36 | 46.8 ± 11.4 (28–72) | Prosthetic valve | If flap elevation is required; chronic liver and renal disease; being on drugs other than warfarin that could affect the liver function or hemostasis; if the patient did not have two teeth to be extracted from the same dental extraction | First dental extraction (group A): warfarin continued
Second dental extraction (15 days after the first) of the same individuals (group B): warfarin stopped 5 days before the procedure with LMWH bridging | LMWH in group B | Dental extractions (more than one tooth from the same dental groups) and no mucoperiosteal flap raised | Oxycellulose dressing and sutures | INR less than 4 | Group A: 2.5 ± 0.3
Group B: 1.1 ± 0.1 | 10 days |
|
| Sacco et al., 2007 [28] | RCT | 131 | Group A: 64 (29–87)
Group B: 61 (29–86) | Not mentioned in the study | Thrombocytopenia less than 100 109/L;
chronic liver and renal disease | Group A (n = 66): warfarin or acenocoumarol stopped until INR between 1.5 and 2 preprocedurally
Group B (n = 65): OAT continued | None | Dental extractions, excision of cysts, implant surgery, and mucoperiosteal flap raised in all patients | Group A: sutures only
Group B: sutures, gelatin, oxycellulose, tranexamic acid | Group A: INR between 1.5 and 2
Group B: INR between 2 and 4 | Group A: 1.77 ± 0.26
Group B: 2.89 ± 0.42 | 7 days |
| Al-Mubarak et al., 2007 [29] | RCT | 214 | Group 1: 52.3 ± 14.3
Group 2: 51.7 ± 14.7
Group 3: 48.7 ± 13.1
Group 4: 53.1 ± 13.7 | Not mentioned in the study | Patients with a history of chronic renal or liver disease and patients on drugs that could affect liver function or hemostasis, other than warfarin | Group 1 (n = 48): no suturing and warfarin stopped 2 days before the procedure
Group 2 (n = 58): no suturing and warfarin continued
Group 3 (n = 56): suturing done and warfarin stopped 2 days prior to the procedure
Group 4 (n = 52): suturing done and warfarin continued | None | Dental extractions | Multiple agents used in all groups
Groups 3 and 4: sutures | Not mentioned in the study | Group 1: 1.8 ± 0.4
Group 2: 2.4 ± 0.5
Group 3: 1.9 ± 0.4
Group 4: 2.7 ± 0.4 | 7 days |
|
| Bajkin et al., 2009 [17] | RCT | 214 | Group A: 62.1 ± 11.4 (31–79)
Group B: 59.6 ± 11 (22–77) | Prosthetic valve replacement, atrial fibrillation, venous thromboembolic disease, ischemic heart disease, cerebrovascular accident, dilated cardiomyopathy, and hereditary thrombophilia | Liver or renal disease; pregnancy; being on drugs that alter the liver function or hemostasis; previous thromboembolic complications while on OAT; history of major bleed during dental extraction before starting OAT; history of heparin-induced thrombocytopenia | Group A (n = 109): warfarin and acenocoumarol continued
Group B (n = 105): OAT stopped 3 to 4 days before the procedure with LMWH bridging | LMWH in group B | Dental extraction and no mucoperiosteal flap raised | Group A: resorbable collagen sponges, without sutures
Group B: none, without sutures | Group A: INR < 4
Group B: INR < 1.5 | Group A: 2.45 ± 0.54
Group B: 1.26 ± 0.11 | 1 month |
| Souto et al., 1996 [30] | RCT | 92 | Initial study: 59.7 ± 9.8
Group 5: 56.3 ± 9.4 | Valvular heart disease (47 patients) or cardiac valve prosthesis (17 patients) | Previous thromboembolic complications while on OAT; history of major bleed during dental extraction before starting OAT; being on OAT for less than 3 months | Groups 0, 1, and 2: acenocoumarol’s dose diminished before the procedure with calcium heparin use
Groups 3, 4, and 5: OAT not changed and heparin not used. The antifibrinolytics used and postprocedural protocols varied between groups | None | Dental extractions | Epsilon-aminocaproic acid and tranexamic acid | In native valves: INR between 2 and 3
In prosthetic valves: INR between 2.5 and 4
Only in group 5: target INR was between 2 and 3 for an aortic prosthesis and from 2.5 to 3.5 for a mitral prosthesis or replacement of both valves | Group 0: 2.5
Group 1: 2.93
Group 2: 2.5
Group 3: 3.29
Group 4: 3.5
Group 5: 2.82 | Unknown |
|
| Clemm et al., 2016 [33]. | CCT | 564 | 56 (18–92) | Atrial fibrillation, artificial heart valves, myocardial infarction, venous thromboembolism, pulmonary embolus, and cardiovascular prophylaxis | Acute or chronic sinusitis (in terms of planned implant placement in the upper jaw); drug or alcohol abuse and smoking; hematological diseases; metabolic, autoimmune, systemic, or immunological diseases; diseases that have an influence on blood coagulation or would negatively influence wound healing; chronic bone disease; untreated periodontitis; current steroid treatment; current chemotherapy; local radiation therapy; pregnancy | Experimental (n = 117): being on one of the following: antiplatelets, VKAs, VKAs discontinued for 3 days with LMWH bridging, or NOACs (dabigatran, rivaroxaban, or apixaban).
Control (n = 447): no anticoagulation | LMWH in the experimental group | Implant and bone grafting surgeries | Sutures and electrocoagulation | Not mentioned in the study | Bridging group: 1.95 ± 0.47
VKA group: 2.62 ± 0.52 | 10 days |
| Cannon and Dharmar, 2003 [34] | CCT | 70 | Experimental: 62.4 (38–80)
Control: 62.4 (36–78) | DVT, PE, TIAs, MI, arrhythmias, valvular disorders, prosthetic valve replacement, coronary artery bypass graft, stroke, and vascular thromboembolism | INR outside the therapeutic range of 2–4; history of liver disease; being on drugs affecting liver function | Experimental (n = 35): warfarin continued
Control (n = 35): warfarin stopped 2 days prior to the procedure | None | Dental extractions, surgical removal, biopsies, closure of oroantral fistula, and mucoperiosteal flap sometimes raised | Experimental: none, except if removal of bone or damage to soft tissue
Control: oxycellulose and sutures | Experimental: INR in the therapeutic range
Control: INR < 2 | In all patients: 3.4 (2.1–4)
Control: 1.6 (1.4–1.9) | 5 days |
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| Devani et al., 1998 [35] | CCT | 55 | Experimental: 64.6 (30–82)
Control: 61.3 (32–81) | DVT, PE, TIAs, MI, arrhythmias, valvular disorders, prosthetic valve replacement, coronary artery bypass graft, stroke, vascular thromboembolism, and dilated cardiomyopathy | INR outside the range of 2.0–4.0; history of liver disease; being on drugs affecting liver function and postoperative hemostasis | Experimental (n = 33): warfarin continued
Control (n = 32): warfarin stopped 2 days prior to the procedure | None | Dental extractions and mucoperiosteal flap sometimes raised | Oxycellulose dressing and sutures | Experimental: INR in the therapeutic range
Control: INR range of 1.5–2.1 | Experimental: 2.7 (2–3.9)
Control: 1.6 (1.2–2.1) | 5 days |
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