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Perioperative Management of Patients Receiving Oral Anticoagulants—Reply
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In reply
We agree with the comments by Chow and Szeto on the use of tranexamic acid to improve hemostasis during dental procedures. Although beyond the scope of our review, the appropriate use of local measures, which may include local pressure, tranexamic acid, tannic acid (biting on tea bags), oxidized cellulose gauze, gelatin sponges, or topical thrombin, is recommended when performing dental surgery on anticoagulated patients.
We appreciate the comments by Kearon and Hirsh on the efficacy of heparin and LMWH therapy on prevention of arterial thromboembolic events. They cite recent studies as indicating that therapy with heparin or LMWH is not as efficacious as warfarin in preventing arterial thromboembolism. The overview of randomized trials listed in favor of their argument, however, is not relevant to the interruption of oral anticoagulation.1 The principal data are based on the Heparin in Acute Embolic Stroke Trial,2 which randomized patients after acute stroke . . . [Full Text of this Article]
Andrew S. Dunn, MD
New York, NY
Alexander G. G. Turpie, MD, FRCP
Hamilton, Ontario
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