Anti-Clotting Drugs: Safe During Surgery

A million Americans who have had heart attacks or strokes caused by blood clots now take anti-clotting drugs regularly to cut down the danger of recurrences. But their blood takes so much longer to clot that dental and other surgeons are confronted with a dilemma: Should they keep a patient on the anticoagulant drug during an operation and run the risk of severe (perhaps fatal) bleeding, or should they take him off the drug for a few days and run the risk of clotting in an artery of the heart or brain? Such authorities as the New England Journal of Medicine and the A.M.A. Journal have been advising surgeons to "play it safe," as they thought, by cutting off the anticoagulants.

This week, with interprofessional cooperation, the Journals of the American Medical Association and American Dental Association printed the same article by two Manhattan specialists who say that "playing it safe" is the most dangerous thing a surgeon can do. Dr. (of dental surgery) Stanley J. Behrman and Dr. (of medicine) Irving S. Wright, both of New York Hospital, have combed the reports of other practitioners and added a detailed study on 40 of their own patients. Their conclusion: "The danger of clotting without the drug is greater than the danger of bleeding with the drug."

If tests show that a patient's clotting time is not unduly prolonged, they say, the surgeon can go ahead, using special techniques to stanch bleeding and to su ture the wound tightly. Oral Surgeon Behrman had one case in which he removed nine teeth, plus a section of the gum, without undue bleeding. Surgeons in other fields have found that it is safer to keep a patient on anticoagulants even for such radical operations as amputating a limb, removing a lobe of a lung, or working inside the heart itself to free a hardened mitral valve. In most of the Behrman-Wright cases, the patients took their anticoagulants (usually drugs of the coumarin family) without a break, even on the day of operation.

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