Skip to main content
Journal cover image

Management of Patients With Left Ventricular Assist Devices Requiring Teeth Extraction: Is Halting Anticoagulation Appropriate?

Publication ,  Journal Article
Suresh, V; Bishawi, M; Manning, MW; Patel, C; Rogers, J; Milano, C; Schroder, J; Daneshmand, M; Powers, D
Published in: J Oral Maxillofac Surg
September 2018

PURPOSE: An increasing number of patients with end-stage heart failure are supported with left ventricular assist device (LVAD) implantation and must be maintained on a consistent anticoagulation regimen. Pre-emptive extraction of carious teeth in these patients is necessary to prevent seeding of the implanted device and endocarditis. Thus, the objective of this study was to evaluate bleeding complications after minor oral surgery, specifically teeth extractions, in this unique patient population requiring long-term anticoagulation. MATERIALS AND METHODS: This study was a retrospective single-center review. Adult patients supported on an implanted continuous-flow LVAD from January 1, 2007 to December 31, 2016 were included. Baseline characteristics were collected by retrospective chart review and the institutional LVAD registry. All extractions were performed in the operating room under local anesthesia with moderate sedation or general anesthesia with nasal intubation, and LVAD settings were monitored by a trained perfusionist. Preoperative and postoperative hematology laboratory values, such as hemoglobin and international normalized ratio (INR), were collected by chart review. Continuous variables were presented as mean ± standard deviation and compared using the Student t test. Categorical variables were presented as proportion and percentage and compared using the χ2 test or Fisher exact test as appropriate. Statistical significance was established at a P value less than .05. RESULTS: After screening 798 patients, 32 (4%) were found to have undergone dental extractions after LVAD implantation. The sample was composed of 32 patients with a mean age of 60.13 years and 81.25% were men. The average time from LVAD implantation to extraction was 445.19 ± 1,108.53 days. Average preoperative INR was 1.76 ± 0.47. Preoperative fresh frozen plasma was not administered to any patients. Twenty-eight patients (87.5%) were on Coumadin (warfarin) preoperatively. In 11 of these 28 patients (39.3%), Coumadin was held preoperatively. The average postoperative change in hemoglobin level was -0.79 ± 1.45. Only 1 patient (3%) required postoperative blood transfusion for a hemoglobin level of 7.6 that responded appropriately. There were no reoperations for bleeding. CONCLUSIONS: Minor oral surgical procedures can be performed safely for patients being supported on LVAD therapy. With primary closure of the gingiva at the site of extraction, dental extractions can be performed without the full reversal of anticoagulation.

Duke Scholars

Published In

J Oral Maxillofac Surg

DOI

EISSN

1531-5053

Publication Date

September 2018

Volume

76

Issue

9

Start / End Page

1859 / 1863

Location

United States

Related Subject Headings

  • Tooth Extraction
  • Risk Factors
  • Retrospective Studies
  • Postoperative Hemorrhage
  • Oral Hemorrhage
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Suresh, V., Bishawi, M., Manning, M. W., Patel, C., Rogers, J., Milano, C., … Powers, D. (2018). Management of Patients With Left Ventricular Assist Devices Requiring Teeth Extraction: Is Halting Anticoagulation Appropriate? J Oral Maxillofac Surg, 76(9), 1859–1863. https://doi.org/10.1016/j.joms.2017.10.022
Suresh, Visakha, Muath Bishawi, Michael W. Manning, Chetan Patel, Joseph Rogers, Carmelo Milano, Jacob Schroder, Mani Daneshmand, and David Powers. “Management of Patients With Left Ventricular Assist Devices Requiring Teeth Extraction: Is Halting Anticoagulation Appropriate?J Oral Maxillofac Surg 76, no. 9 (September 2018): 1859–63. https://doi.org/10.1016/j.joms.2017.10.022.
Suresh V, Bishawi M, Manning MW, Patel C, Rogers J, Milano C, et al. Management of Patients With Left Ventricular Assist Devices Requiring Teeth Extraction: Is Halting Anticoagulation Appropriate? J Oral Maxillofac Surg. 2018 Sep;76(9):1859–63.
Suresh, Visakha, et al. “Management of Patients With Left Ventricular Assist Devices Requiring Teeth Extraction: Is Halting Anticoagulation Appropriate?J Oral Maxillofac Surg, vol. 76, no. 9, Sept. 2018, pp. 1859–63. Pubmed, doi:10.1016/j.joms.2017.10.022.
Suresh V, Bishawi M, Manning MW, Patel C, Rogers J, Milano C, Schroder J, Daneshmand M, Powers D. Management of Patients With Left Ventricular Assist Devices Requiring Teeth Extraction: Is Halting Anticoagulation Appropriate? J Oral Maxillofac Surg. 2018 Sep;76(9):1859–1863.
Journal cover image

Published In

J Oral Maxillofac Surg

DOI

EISSN

1531-5053

Publication Date

September 2018

Volume

76

Issue

9

Start / End Page

1859 / 1863

Location

United States

Related Subject Headings

  • Tooth Extraction
  • Risk Factors
  • Retrospective Studies
  • Postoperative Hemorrhage
  • Oral Hemorrhage
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Female