In some cases, the patient's medical health status and the drugs taken influenced the blood coagulation. These patients present either medically anticoagulated for thrombosis, heart valve replacement, atrial fibrillation, stroke, and embolism or inherited coagulopathies as in the case of hemophilia. It is wise to consult with the patient's physician before the operation to prepare for the best management strategy. To select the best strategy for the patient, the dentist must understand the function of various drugs used in anticoagulation therapies. Some of the drugs used in anticoagulation are:
- Coumadin (Warfarin) used to block the extrinsic coagulation pathway with an effective half-life of three days. The blood coagulation process level appropriates for surgery of the patient who discontinues Coumadin occurs in three days.
- Aspirin works by interfering with blood platelet adhesion and last throughout the life of the blood platelet. Therefore, the patient needs to discontinue the drug seven days before surgery.
- The following herbal supplements may keep the patient's blood from clotting: garlic, ginger, St. Johns Wort, Chondrotin sulfate, Turmeric, fish oil, Ginseng, and gingko biloba
- Removal of all granulation tissue and tooth remnants from the socket
- Avoid traumatize the soft tissue around the socket
- Adequate irrigation to keep the socket clean
- Pack the socket with hemostatic agents such as Gel-foam, Surgicel, Helistat, Sulzer, or Avitene Davol
- Appropriate closure of the wound by suturing if necessary
- Instruct the patient to bite down on gauze for 20-30 minutes
- Recommend the patient to avoid rinsing the mouth and smoking for 24 hours
- Avoid eating hot foods or drinks
- When the patient reports bleeding at home, advise the patient to moisten the tea bag in cool water before biting on it for 20 minutes (Tannic acid in tea helps blood clot)
- If the bleeding persist, ask the patient to return to the office for an assessment. Some patient may develop incomplete blood clot that requires re-cleaning the socket to allow the most stable clot to form.