In case that the dental process is not considered to be of high risk for bleeding, it is not necessary to stop OAC.

At the same time, the risk of thrombosis should be taken into account, so one should balance benefit and risk in individual basis.

In tooth extraction, I would definetely stop OAC 2-3 days before the procedure, unless being sure that bleeding can be adequately controlled.

I usually stop OAC and shift to clexane or heparin to avoid bleeding

I ask my patient to do (INR) if = or < 2 No problem to proceed if >2 advise him to DC OAC 3Days then do extraction on the 4th D and resume OAC after that

I agree with you. this the safe way to protect your patients from thrmbo-embolic complication. in fact this the policy I am using for my patients.

Hello thanks for your responses. In fact there are two attitudes, either OAC is substituted by heparin, or OAC is not stopped before extraction when bleeding and thrombosis risks are low. some guidelines recommand not to stop OAC for simple tooth extraction procedures (1 or 2 teeth) with INR

I avoid to stop OAC for simple dental procedures or simple dental extraction in every patients, specially in patients with mechanical prosthesis or previous stoke. If the INR is >4 the dental procedure is posponed. Complex dental procedures, with high risk of bleeding should be performed in hospital.

Hi José I agree with you studies showed that for simple tooth extraction and minor oral surgery there is no need to stop OAC. The risk of thrombosis is higher than bleeding which can be controlled. Dentists and cardiologist shall communicate together for a better care of the patient. thanks

We stop OAC with AVK 2 to 3 days, starting enoxaparin /12h sc until12h before the moment of the extraction, then 2 to 3 days of enoxaparin starting 12h after until the moment the desired INR with OAC is reached. If bleeding risk is no high, OAC is not stopped, and just local hemostasia and tranexamic-water solution washing is recomended

We stop OAC with AVK 2 to 3 days, starting enoxaparin /12h sc until12h before the moment of the extraction, then 2 to 3 days of enoxaparin starting 12h after until the moment the desired INR with OAC is reached. If bleeding risk is no high, OAC is not stopped, and just local hemostasia and tranexamic-water solution washing is recomended