ASSESSMENT OF COAGULATION STATUS AFTER TOOTH EXTRACTION IN PATIENTS WITH ATRIAL FIBRILLATION RECEIVING ANTICOAGULANT THERAPY: MODERN APPROACHES
Keywords:
atrial fibrillation, anticoagulant therapy, tooth extraction, coagulation status, warfarin, direct oral anticoagulants, bleeding risk, local hemostasis.Abstract
This article analyzes current approaches to assessing coagulation status after tooth extraction in patients receiving long-term anticoagulant therapy due to atrial fibrillation (AF). Balancing the risk of bleeding and thromboembolic complications during dental procedures in patients treated with warfarin and direct oral anticoagulants (DOACs), including apixaban, rivaroxaban, dabigatran, and others, remains a significant clinical challenge. The article reviews the bleeding risk associated with tooth extraction, key coagulation parameters such as international normalized ratio (INR), anti-factor Xa activity, and thrombin time, in the context of European and American cardiology and dental clinical guidelines. In addition, local hemostatic measures (hemostatic sponges, tranexamic acid mouthwashes, sutures) and clinical decision-making algorithms regarding continuation or temporary interruption of anticoagulant therapy are discussed. Recent studies suggest that for most low-risk dental procedures, complete discontinuation of DOACs is not required, and an individualized approach based on thromboembolic and bleeding risk assessment (CHA₂DS₂-VASc, HAS-BLED) and coagulation monitoring is preferred.Downloads
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