DIRECT ORAL ANTICOAGULANTS AND MEDICAL COMORBIDITIES

Patients who are taking oral anticoagulant drugs such as Coumadin or Plavix (as examples) can be divided into about 10,000 groups based on their medication, age, medical problems, history, genetics, dosage, the treatment needed (to name a few). In other words there is no simple one-size-fits-all answer to this question/problem of how do you manage a patient on oral anticoagulants who needs an oral surgery procedure. (J Oral Maxillofac Surg 77:463-470, 2019).

There are some simple rules-of-thumb that we follow and they all boil down to the idea that we need to “know” our patient as much as possible and then use good judgement and tried surgical techniques to control bleeding as much as possible. Along with that, a well-informed patient and family/support personnel as to how to deal with problems as they arise, goes a long way to head off problems. Some very basic fact-finding with the patient, patient’s family, and patient’s primary care doctor will usually answer the questions required to make good decisions for an experienced, well-trained surgeon.

The article that I site discusses the effect of comorbidities such as diabetes as predictors. Frankly, I have found that trying to predict based on comorbidities has a limited use. Clearly, a patients’ other medical problems as a list is good to have – but these need to be assessed as they relate to how they are affecting “this” patient. We see patients with multiple serious medical concerns who know their own health well and have good control. They will have a much lower risk than someone who does not understand their own disease such as hypertension and who has poor control.

Again, these are complicated issues and proper discernment, follow through, and responsible surgical care work best to save us from having problems.