Clinical protocols for tooth extraction in geriatric patients treated with anticoagulants and antiplatelet drugs

Abstract

Geriatric patient have an increased cardiovascular risk, and ischemic heart disease is the most common cause of death in the ederly. Age results in changes in the homeostasis as increased coagulability, decreased fibrinolysis and increased platelet aggregability. These factors together with endothelial dysfunction and increased blood stasis, involve an increased thrombotic risk and the possibility of having a cardiovascular event. The use of oral anticoagulants and antiplatelet drugs has amply demonstrated its effectiveness in both primary and secundary prevention of thrombotic events. Surgical procedures, such as dental extraction, in patiens with antithrombotic therapy may entail to an increased risk of bledding during the procedure and in the postoperative period. On the other hand, the removal of these drugs in order to reduce bledeing may increase the risk of developing a thromboembolic event with fatal consequences for the patient´shealth. The purpose of this paper is to review antithrombotic drugs currently used and protocols for patients on anticoagulation/antiplatelet therapy who need a dental extraction.