Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2016Introduction: The therapeutical approach of patients under chronic antithrombotic therapy needing dental procedures causes great controversy. The increased hemorrhage risk associated with these procedures when the patient is undergoing this therapy must be taken into account relatively to the increased thrombotic risk caused by its interruption. The aim of this study was to review the current literature regarding antithrombotic therapy and its implications in medical dentistry. Materials and Methods: Research was performed from November 2015 until May 2016 on the databases Cochrane Library, Medline (via PubMed) and Google Scholar, with the key-words: Anticoagulants Dental Surgery; Hemostasis; Cell-based Model Hemostasis; Antiplatelet Therapy Oral Surgery; New Oral Anticoagulants Dental Procedures; filtered by the following formats: Meta-analysis, Systematic Reviews and Randomized Control Trials, which were extended afterwards to include Reviews, Cohorts and Guidelines. Inclusion criteria consisted of articles published in the last 10 years, available in English or Portuguese, limited to human samples. Articles were also retrieved after analyzing the reference list of articles previously obtained. Results: The search yielded 1242 results, of which 47 were selected for inclusion, and 21 additional articles were obtained from the reference lists of other articles. Results point to the fact that, currently, several authors suggest the execution of the procedures without therapy modification or discontinuation, emphasizing preventive local hemostatic measures, with the interruption of antithrombotic therapy before surgical interventions possibly leading to severe consequences. Conclusion: Minor oral surgery procedures are considered to be of low hemorrhagic risk. Therefore, there is no indication for the interruption of antithrombotic therapy, provided there are no additional risk factors, the patient is stably anticoagulated, and local hemostatic measures are properly applied. However, patients requiring extensive oral/maxillofacial surgery may need discontinuation of oral anticoagulants preoperatively, but always in conjunction with the treating physician
