Que hacer si se toma Sintrom, clopidogrel o AAS y se va al dentista

Muchos pacientes son derivados por los odontólogos para modificar o retirar la pautra de antiagregación o anticoagulación de un paciente antes de realizar un tratamiento o una extracción. El consejo habitual de los dentistas es suspender el tratamiento. En absoluto es necesario.
En este documento se encuentran las recomendaciones del Guidelines for the management of patients on oral anticoagulants requiring dental surgery del British Committee for Standards in Haematology.

Summary of key recommendations

1. The risk of significant bleeding in patients on oral anticoagulants and with a stable INR in the therapeutic range 2-4 (i.e. <4) is very small and the risk of thrombosis may be increased in patients in whom oral anticoagulants are temporarily discontinued. Oral anticoagulants should not be discontinued in the majority of patients requiring out-patient dental surgery including dental extraction (grade A level Ib).
2. Recommendations: For patients stably anticoagulated on warfarin (INR 2-4) and who are prescribed a single dose of antibiotics as prophylaxis against endocarditis, there is no necessity to alter their anticoagulant regimen (grade C, level IV).
3. The risk of bleeding may be minimised by: a. The use of oxidised cellulose (Surgicel) or collagen sponges and sutures (grade B, level IIb). b. 5% tranexamic acid mouthwashes used four times a day for 2 days (grade A, level Ib). Tranexamic acid is not readily available in most primary care dental practices.
4. For patients who are stably anticoagulated on warfarin, a check INR is recommended 72 hours prior to dental surgery (grade A, level Ib)
5. Patients taking warfarin should not be prescribed non-selective NSAIDs and COX-2 inhibitors as analgesia following dental surgery (grade B, level III).

Disponemos también las recomendaciones publicadas en 2004 en el Boletín Terapéutico Andaluz.
Por cierto, he sido incapaz de encontrar unas recomendaciones españolas actualizadas dirigidas a los dentistas para la actuación en estas situaciones.