Comparison of cardiovascular response between patients on warfarin and hypertensive patients not on warfarin during dental extraction

• Published in: Clinical oral investigations 2021-04, Vol.25 (4), p.2141-2150
• Main Authors: Kubota, Kazumasa, Yamaga, Eijiro, Ueda, Kaori, Inokoshi, Masanao, Minakuchi, Shunsuke
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anticoagulants; Blood Pressure; Cardiovascular diseases; Dentistry; Hemorrhage; Humans; Hypertension; Hypertension - drug therapy; Local anesthesia; Male; Medicine; Original Article; Patients; Retrospective Studies; Sutures; Thromboembolism; Tooth Extraction; Warfarin
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-020-03526-8

Objective To evaluate cardiovascular response in patients on warfarin and hypertensive patients not on warfarin during dental extraction. Materials and methods This retrospective study included 53 patients who had undergone dental extraction while on warfarin (mean age 78.8 ± 6.3 years, 26 men) and 66 with hypertension who had undergone dental extraction but were not on warfarin (mean age 77.4 ± 6.8 years, 22 men). Vital signs were monitored in both groups during extraction. Results The highest systolic blood pressure (SBP) values (mean 150.1 ± 21.1 mmHg) were observed in patients on warfarin before (9.0%) and after (10.3%) administration of local anesthesia (LA), during extraction (39.7%), and during (33.3%) and after (7.7%) suturing ( n = 78; p < 0.01), and in hypertensive patients not receiving warfarin (160.6 ± 24.8 mmHg) before (19.2%) and after (27.3%) administration of LA, during extraction (29.3%), and during (18.2%) and after (6.1%) suturing ( n = 99; p < 0.01). The highest SBP was linearly correlated with SBP before administration of LA in patients on warfarin (highest SBP = 0.9415 × SBP before LA + 23.243, R 2 = 0.75481) and in hypertensive patients not on warfarin (highest SBP = 1.0027 × SBP before LA + 15.789, R 2 = 0.60341). Conclusions The highest SBP was not distributed evenly between patients on warfarin and hypertensive patients not on warfarin during dental extraction and was strongly associated with SBP before LA regardless of anticoagulant status. Clinical relevance Thorough management of SBP is required in patients on warfarin to avoid thromboembolism and major hemorrhagic complications. Knowing the SBP value before dental treatment would help predict the risk of cardiovascular complications.