Oral surgery in anticoagulated patients without reducing the dose of oral anticoagulant: a prospective randomized study

J Oral Maxillofac Surg. 1996 Jan;54(1):27-32; discussion 323. doi: 10.1016/s0278-2391(96)90297-9.


Purpose: This study assessed the risk associated with several schedules of perioperative treatment with coumadin in anticoagulated patients who underwent oral surgery.

Patients and methods: A prospective, randomized study compared bleeding complications with six perioperative schedules in 92 patients chronically treated with acenocoumarol. In three of the perioperative schedules, the dose was reduced before surgery and calcium heparin was added. In the other three, oral anticoagulation was not modified and heparin was not used. The groups also differed regarding the antifibrinolytic agents used and the postoperative measures applied.

Results: Those schedules in which the oral anticoagulation was not modified preoperatively and an antifibrinolytic agent was applied locally both during and after surgery were not associated with a significantly higher odds ratio of bleeding complications than those in whom oral anticoagulation was reduced and calcium heparin was added preoperatively.

Conclusions: In orally anticoagulated patients who undergo oral surgery, schedules that maintain the oral anticoagulant regimen and use local tranexamic acid as an antifibrinolytic agent postoperatively for 2 days are safe, simple, and less troublesome.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acenocoumarol / administration & dosage
  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Antifibrinolytic Agents / administration & dosage
  • Chi-Square Distribution
  • Dental Care for Chronically Ill / methods*
  • Female
  • Heart Valve Diseases
  • Heart Valve Prosthesis
  • Heparin / administration & dosage
  • Humans
  • Logistic Models
  • Male
  • Mouthwashes / therapeutic use
  • Odds Ratio
  • Prospective Studies
  • Thromboembolism / prevention & control*
  • Tooth Extraction*
  • Tranexamic Acid / administration & dosage


  • Anticoagulants
  • Antifibrinolytic Agents
  • Mouthwashes
  • Tranexamic Acid
  • Heparin
  • Acenocoumarol