Anticoagulated Patients and Oral Surgery

I am writing to you and your readers regarding the topic of oral surgery procedures in patients who are taking oral anticoagulant therapy for a variety of conditions. This topic has had considerable debate in the literature for quite some time. Traditionally, many oral surgeons have consulted with the medical community and reduced the dose of anticoagulation prior to a procedure and then resumed therapy. My experience over that past 8 years is that this approach works quite well except for patients with prosthetic valve replacement. It seems, however, that many in the medical community recently have concluded that withdrawal of anticoagulant therapy is not indicated for oral surgery due to the risk of thromboembolic events and the low risk of bleeding events for these patients. While I agree that this is true in many patients, I do not think it can be so uniformly applied that no consideration be given to the individual patient, the reason for anticoagulation (atrial fibrillation vs deep vein thrombosis vs prosthetic valve), and the nature of the procedure. A variety of procedures are required for our patients and the bleeding, while never life threatening, can be quite disconcerting and require repeated local measures, and occasionally require further modification of the anticoagulation therapy that was initially not desired.