Local Hemostasis as the Critical Enabler for Safe Antithrombotic Therapy in Dentistry—Navigating Future Frontiers and Innovative Concepts

TL;DR

This paper reviews how local hemostasis can safely allow patients to continue antithrombotic therapy during dental surgery, reducing risks of both bleeding and blood clots.

Contribution

The paper introduces a patient-centered clinical framework that emphasizes local hemostasis to safely manage antithrombotic therapy in dental procedures.

Findings

Advanced local hemostasis techniques allow safe continuation of antithrombotic therapy in most dental surgeries.

Discontinuing anticoagulants increases thromboembolic risks without significantly reducing bleeding.

Future research should focus on optimizing biomaterials and standardizing protocols for high-risk patients.

Abstract

Perioperative management of antithrombotic therapy in oral surgery represents an evolving paradigm. This critical review evaluates the contemporary scientific evidence that challenges the conventional practice of routinely discontinuing anticoagulants and/or antiplatelet agents to prevent postoperative bleeding. The traditional strategy carries an unacceptable risk of iatrogenic, sometimes severe, thromboembolic events. The aim of this systematic narrative review is to synthesize the current evidence (2015–2025) and to outline a new, patient-centered clinical framework that dynamically balances thromboembolic and hemorrhagic risks. Materials and methods: A systematic search of major databases (PubMed/MEDLINE, Scopus, Web of Science) identified relevant studies, structured according to the PICO framework. The search strategy prioritized high-level evidence, including clinical guidelines, systematic reviews, meta-analyses, randomized controlled trials, and prospective cohort studies published between January 2015 and November 2025. Results: The results reinforce an emerging consensus: the basis of safe management is the rigorous application of advanced local hemostasis techniques (e.g., prioritizing resorbable materials, sutures, topical hemostatic agents, and antifibrinolytics) and the use of perioperative decision-making algorithms. These measures allow, in most routine dental surgical procedures, the safe continuation of antithrombotic therapy, thus minimizing the thromboembolic risk without significantly increasing the risk of clinically significant bleeding. In the future, research should focus on optimizing materials science (novel biomaterials and controlled-release systems) and on standardizing and validating protocols in specific populations (e.g., patients on combination therapy or at extreme cardiovascular risk). This review argues that the adoption of this evidence-based model, with local hemostasis as a critical pillar, is essential for modern, ethical, and safe dental practice.

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