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Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery: Part 2
Benjamin J. StatmanDDS
Article Category: Research Article
Volume/Issue: Volume 70: Issue 1
Online Publication Date: Mar 28, 2023
DOI: 10.2344/anpr-70-01-06
Page Range: 37 – 48

PERIOPERATIVE MANAGEMENT OF PATIENTS TAKING ORAL ANTITHROMBOTICS Management of oral antithrombotics (OATs) for patients undergoing dental procedures with sedation or general anesthesia requires understanding the factors used to weigh the risks and benefits of continuing or stopping OATs perioperatively and framing treatment modifications to fit with the proposed surgical and anesthetic procedures. Questions that must be addressed include the following: 1) whether OAT agents should be continued, “bridged” (ie, temporarily substituted), or

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Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery: Part 1
Benjamin J. StatmanDDS
Article Category: Other
Volume/Issue: Volume 69: Issue 3
Online Publication Date: Oct 06, 2022
DOI: 10.2344/anpr-69-03-05
Page Range: 40 – 47

anesthesia providers to understand the indications for these drugs as well as their pharmacokinetic and pharmacodynamic characteristics to minimize excessive blood loss as well as thrombotic or thromboembolic complications. Part 2 of this review will discuss the factors involved in determining if the hemostatic benefits of stopping these antithrombotic agents outweigh the thrombotic and thromboembolic risks associated with their cessation. If it is determined that cessation is necessary, the pharmacologic features outlined above will guide the optimal timing of

Antithrombotic Drugs: Pharmacology and Implications for Dental Practice
Daniel E. BeckerDDS
Article Category: Other
Volume/Issue: Volume 60: Issue 2
Online Publication Date: Jan 01, 2013
DOI: 10.2344/0003-3006-60.2.72
Page Range: 72 – 80

Antithrombotic drugs are prescribed extensively in medical practice, and an impressive number of formulations have been introduced in recent years. Although these medications do not significantly impact the use of sedation or anesthesia per se, they certainly introduce concerns regarding postoperative bleeding and a potential for significant drug interactions. To evaluate and understand these risks it is essential to have an understanding of thrombogenesis and the various classes of antithrombotic drugs. Thrombogenesis (clot

Cardiovascular Drugs: Implications for Dental Practice Part 2—Antihyperlipidemics and Antithrombotics
Daniel E. BeckerDDS
Article Category: Research Article
Volume/Issue: Volume 55: Issue 2
Online Publication Date: Jan 01, 2008
DOI: 10.2344/0003-3006(2008)55[49:CDIFDP]2.0.CO;2
Page Range: 49 – 56

interactions with certain antimicrobials that may be prescribed by the dentist. 1 Macrolide antibiotics such as erythromycin and azole antifungal agents such as ketoconazole should be avoided in patients taking any of the statins. These antimicrobials elevate the serum levels of statins, which increases their risk for myopathy and possible hepatotoxicity. Tetracycline preparations will be absorbed poorly in patients taking bile acid sequestrants. Antithrombotic Agents Antithrombotic drugs are prescribed extensively in medical practice

Figure 1; Summary of thrombogenesis and thrombolysis. A thrombus consists of 2 principal components: an aggregate of platelets and a fibrin mesh. Platelet activity consists of adherence to vessel walls (adhesion) and to one another (aggregation). The fibrin mesh is synthesized during a complex cascade of enzymatic reactions leading to the formation of fibrin strands (coagulation). The body also has a natural thrombolytic system, essentially comprised of plasmin, an enzyme that cleaves fibrin strands. Antithrombotic drugs are classified according to action on each of these processes: antiplatelet drugs, anticoagulants, and thrombolytics (fibrinolytics).
Daniel E. Becker
Figure 1
Figure 1

Summary of thrombogenesis and thrombolysis. A thrombus consists of 2 principal components: an aggregate of platelets and a fibrin mesh. Platelet activity consists of adherence to vessel walls (adhesion) and to one another (aggregation). The fibrin mesh is synthesized during a complex cascade of enzymatic reactions leading to the formation of fibrin strands (coagulation). The body also has a natural thrombolytic system, essentially comprised of plasmin, an enzyme that cleaves fibrin strands. Antithrombotic drugs are classified according to action on each of these processes: antiplatelet drugs, anticoagulants, and thrombolytics (fibrinolytics).

Figure 1. ; Thrombogenesis. A thrombus consists of 2 principal components: an aggregate of platelets and a fibrin mesh. Platelet activity consists of adherence to vessel walls (adhesion) and to one another (aggregation). The fibrin mesh is synthesized during a complex cascade of enzymatic reactions leading to the formation fibrin strands (coagulation). The body also has a natural thrombolytic system, essentially comprised of plasmin, an enzyme that cleaves fibrin strands. Antithrombotic drugs are classified according to action on each of these processes: antiplatelet drugs, anticoagulants, and thrombolytics (fibrinolytics).
Daniel E. Becker
<bold>Figure 1.</bold>
Figure 1.

Thrombogenesis. A thrombus consists of 2 principal components: an aggregate of platelets and a fibrin mesh. Platelet activity consists of adherence to vessel walls (adhesion) and to one another (aggregation). The fibrin mesh is synthesized during a complex cascade of enzymatic reactions leading to the formation fibrin strands (coagulation). The body also has a natural thrombolytic system, essentially comprised of plasmin, an enzyme that cleaves fibrin strands. Antithrombotic drugs are classified according to action on each of these processes: antiplatelet drugs, anticoagulants, and thrombolytics (fibrinolytics).

Figure 1.; Classic coagulation cascade model featuring the extrinsic, intrinsic, and common coagulation pathways.
Benjamin J. Statman
Figure 1.
Figure 1.

Classic coagulation cascade model featuring the extrinsic, intrinsic, and common coagulation pathways.

Figure 2.; Contemporary coagulation model demonstrating the 3 phases: activation (A-C), amplification (D-F), and clot propagation (G).3
Benjamin J. Statman
Figure 2.
Figure 2.

Contemporary coagulation model demonstrating the 3 phases: activation (A-C), amplification (D-F), and clot propagation (G).3

General Anesthesia During Lip Repair and Palatoplasty After Glenn Surgery
Kaoru Yamashita,
Toshiro Kibe,
Atsushi Kohjitani,
Yurina Higa,
Ayako Niiro,
Minako Uchino,
Kanae Aoyama,
Rumi Shidou,
Kohei Hashiguchi, and
Mitsutaka Sugimura
Article Category: Research Article
Volume/Issue: Volume 67: Issue 2
Online Publication Date: Jul 06, 2020
DOI: 10.2344/anpr-67-02-05
Page Range: 107 – 108

patients on anticoagulant or antiplatelet therapy. Our patient had been treated with aspirin as the antithrombotic regimen; however, after hospital admission, it was substituted for heparin, which was started 1 week prior to surgery. Furthermore, intraoral bleeding can lead to airway loss and hypoxemia, which are especially problematic for patients with left ventricular hypoplasia. Therefore, it is important to carefully assess bleeding before extubation. In conclusion, the risks of increased pulmonary vascular resistance, hypoxemia, and increased bleeding must

Cardiovascular Considerations in Anesthetic Management for a Patient With Antiphospholipid Syndrome and Decreased Cardiac Function: A Case Study
Makiko ShibuyaDDS, PhD,
Yukifumi KimuraDDS, PhD,
Shigeru TakumaDDS, PhD,
Nobuhito KamekuraDDS, PhD, and
Toshiaki FujisawaDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 68: Issue 1
Online Publication Date: Apr 07, 2021
DOI: 10.2344/anpr-67-03-07
Page Range: 33 – 37

from oral warfarin to continuous unfractionated heparin, which was started 5 days before and discontinued 3 hours before the surgery. Noninvasive antithrombotic therapy consisting of elastic stockings and intermittent pneumatic compression devices was also used throughout the perioperative period. Aspirin administration was continued as well, as the attending oral surgeon deemed adequate hemostasis likely achievable despite its continued use. Because of poor peripheral venous access, a central venous catheter was placed in the right internal jugular vein