Pharmacologic Management of Patients with Drug-Related Coagulopathies

With the increasing prevalence and complexity of patients on antiplatelet and anticoagulant therapy, the dental clinician is routinely faced with managing these patients in the practice setting. Understanding clinical hemostasis and the underlying physiology associated with surgical injury and bleeding allows the clinician to plan and manage preoperative, intraoperative, and postoperative bleeding risk in patients on “blood thinners.” Additionally, a new class of drugs known as Direct Oral Anticoagulants (DOACs) creates additional challenges for the dentist and physician when managing these dental patients. In the past, the dental clinician’s initial approach has often been whether to reduce or withdraw medications before dental procedures. However, evidence has demonstrated that, in most instances, these patients can and should be maintained on their antiplatelet/anticoagulant regimen when undergoing dental procedures, including dental extractions. Prolonged or increased bleeding in these patients, especially those on single or dual antiplatelet therapy, is generally a manageable challenge or inconvenience but rarely life-threatening. With good communication and planning with the patient’s physician, proper technique, and the use of hemostatic agents, the dental clinician can typically anticipate, plan for, and manage any increased or prolonged bleeding episodes.