***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This prospect i ve r and omized study analyses the use of a prescribed 4.8 % tranexamic acid post-operative mouthwash over 2 days vs 5 days to prevent bleeding in patients taking warfarin who require dental extraction s. Eighty-five patients therapeutically anticoagulated with warfarin for various conditions , ranging in age from 21 to 86 years and requiring dental extraction s , were r and omly divided into two groups . Group A postoperatively received a 4.8 % tranexamic acid mouthwash to be used over a 2-day period . Group B received the same mouthwash and instructions postoperatively , to be taken over 5 days . All procedures were performed on an ambulatory basis under local anaesthetic by the same surgeon . Patients were review ed 1 , 3 , and 7 days postoperatively to assess bleeding . Eighty-two of the 85 patients encountered no postoperative problems . Two patients in group A and one in group B had minor postoperative bleeds that required minor ambulatory intervention to control . This study shows that a 2-day postoperative course of a 4.8 % tranexamic acid mouthwash is as equally effective as a 5-day course in controlling haemostasis post-dental extraction s in patient 's anticoagulated with warfarin OBJECTIVE To estimate the 3-month cumulative incidence of thromboembolism ( TE ) , bleeding , and death among consecutive patients with nonvalvular atrial fibrillation ( AF ) who were receiving long-term anticoagulation therapy and were referred to the Thrombophilia Center at Mayo Clinic for periprocedural anticoagulation management . PATIENTS AND METHODS In a prospect i ve cohort study of consecutive patients receiving long-term anticoagulation therapy who were referred to the Thrombophilia Center for periprocedural anticoagulation management over the 7-year period , January 1 , 1997 , to December 31 , 2003 , 345 patients with nonvalvular AF were eligible for inclusion .  Warfarin was stopped 4 to 5 days before and was restarted after surgery as soon as hemostasis was assured . The decision to provide bridging therapy with heparin was individualized and based on the estimated risks of TE and bleeding . RESULTS The 345 patients with AF ( mean + /- SD age , 74+/-9 years ; 33 % women ) underwent 386 procedures . Warfarin administration was not interrupted for 44 procedures . Periprocedural heparin was provided for 204 procedures . Patients receiving heparin were more likely to have prior TE ( 43 % vs 24 % ; P<.001 ) and a higher CHADS2 ( congestive heart failure , hypertension , age , diabetes , stroke ) score ( 2.2 vs 1.9 ; P=.06 ) . Four patients had 6 episodes of TE ( 3 strokes and 3 acute coronary episodes ; TE rate , 1.1 % ; 95 % confidence interval , 0.0%-2.1 % ) . Nine patients had 10 major bleeding events ( major bleeding rate , 2.7 % ; 95 % confidence interval , 1.0%-4.4 % ) . There were no deaths . Neither bleeding nor TE rates differed by anticoagulant management strategy . CONCLUSION The 3-month cumulative incidence of TE and bleeding among patients with AF in whom anticoagulation was temporarily interrupted for an invasive procedure was low and was not significantly influenced by bridging therapy Objective : The management of anticoagulated patients with warfarin during dental extraction is an intricate issue . We carefully design ed the current study so that the amount of bleeding was measured with objective methods and the data from the same patient in different dental extraction appointments could be compared , eliminating the bleeding diathesis differences of patients . Methods : This prospect i ve and controlled study was conducted in 36 adult patients with prosthetic valve requiring multiple tooth extraction s. The first dental extraction was performed without the discontinuation of warfarin therapy , and the second procedure was performed with a discontinuation of warfarin and bridging with low-molecular weight heparin ( LMWH ) . The two dental extraction protocol s in the same patient group were compared . The total amount of bleeding was calculated as the difference between the weights of gauze swabs used before and after the tamponade ; the number of gauze swabs used for bleeding control in the first 48 h was recorded . Result : The median number of used gauze swabs was 2.5 ( IQR : 1–5 ) and 3.0 ( IQR : 2–7 ) in the first and second dental extraction procedures , respectively . The median bleeding time was 50.0 ( IQR : 20–100 ) in the first procedure compared with 60.0 ( IQR : 40–140 ) min in the second procedure . The mean amounts of bleeding were 2194±1418 mg in the first dental extraction procedure and 2950±1694 mg in the second dental extraction procedure . The median number of used gauze swabs , the median bleeding time , and the mean amount of bleeding were statistically higher in the second dental extraction procedure ( p<0.001 ) . Conclusion : Continued warfarin treatment at the time of dental extraction s reduces the total amount of bleeding compared with bridging therapy in patients with prosthetic valves BACKGROUND Patients on therapeutic anticoagulation are at risk of bleeding from minor oral surgical sites . When the anticoagulant regime is modified to prevent the risk of bleeding , this at the same time predisposes the patient to risks of the medical condition for which they are being treated . METHODS A total of 70 patients who were on warfarin treatment requiring minor oral surgical procedures were treated in the Oral Surgery Department . A control group of 35 had their warfarin stopped prior to the minor oral surgical procedure . The other 35 formed the study group . Patients with an International Normalized Ratio outside the therapeutic range of 2 - 4 , or with history of liver disease or on drugs affecting liver function were excluded from the study . Any incidences of post-operative bleeding were recorded . RESULTS None of the patients in either control or study group had any serious bleeding complications . CONCLUSION The data suggest that patients can safely undergo routine minor oral surgical procedures without alterations of their therapeutic anticoagulation regime We found no prospect i ve studies on dental extraction in anticoagulated patients in the literature , even though most authors suggest that there is no need to change anticoagulant treatment and to utilize a local haemostatic measure after extraction . In the present study , we have verified the incidence of bleeding complications after dental extraction  in a group of 250 consecutive anticoagulated patients . Two hundred and fifty non-anticoagulated subjects requiring dental extraction represented the control group . In all patients , anticoagulant treatment was not changed ( International Normalized Ratio , 1.8–4 ) and local haemostatic measures ( fibrin sponge , silk suture and a gauze saturated with tranexamic acid ) were used . All procedures were performed in an outpatient clinic setting . We registered four bleeding complications in the group of anticoagulated patients and three in the control group . The difference of bleeding complications in the two groups was not statistically different ( relative risk , 1.14 ; 95 % confidence interval , 0.29–6.04 ; P = 0.7 ) . None of the post-operative late bleeding required hospitalization and /or blood transfusions , and further local measures were sufficient to stop the bleeding . The protocol proposed in the present study makes dental extraction s in anticoagulated patients possible on an outpatient basis with a cost reduction for the community and minor discomfort for the patients Background — Dabigatran reduces ischemic stroke in comparison with warfarin ; however , given the lack of antidote , there is concern that it might increase bleeding when surgery or invasive procedures are required . Methods and Results — The current analysis was undertaken to compare the periprocedural bleeding risk of patients in the R and omized Evaluation of Long-Term Anticoagulation Therapy ( RE-LY ) trial treated with dabigatran and warfarin .  Bleeding rates were evaluated from 7 days before until 30 days after invasive procedures , considering only the first procedure for each patient . A total of 4591 patients underwent at least 1 invasive procedure : 24.7 % of patients  received dabigatran 110 mg , 25.4 % received dabigatran 150 mg , and 25.9 % received warfarin , P=0.34 . Procedures included : pacemaker/defibrillator insertion ( 10.3 % ) , dental procedures ( 10.0 % ) , diagnostic procedures ( 10.0 % ) , cataract removal ( 9.3 % ) , colonoscopy ( 8.6 % ) , and joint replacement ( 6.2 % ) . Among patients assigned to either dabigatran dose , the last dose of study drug was given 49 ( 35–85 ) hours before the procedure on comparison with 114 ( 87–144 ) hours in patients receiving warfarin , P<0.001 . There was no significant difference in the rates of periprocedural major bleeding between patients receiving dabigatran 110 mg ( 3.8 % ) or dabigatran 150 mg ( 5.1 % ) or warfarin ( 4.6 % ) ; dabigatran 110 mg versus warfarin : relative risk , 0.83 ; 95 % CI , 0.59 to 1.17 ; P=0.28 ; dabigatran 150 mg versus warfarin : relative risk , 1.09 ; 95 % CI , 0.80 to 1.49 ; P=0.58 . Among patients having urgent surgery , major bleeding occurred in 17.8 % with dabigatran 110 mg , 17.7 % with dabigatran 150 mg , and 21.6 % with warfarin : dabigatran 110 mg ; relative risk , 0.82 ; 95 % CI , 0.48 to 1.41 ; P=0.47 ; dabigatran 150 mg : relative risk , 0.82 ; 95 % CI , 0.50 to 1.35 ; P=0.44 . Conclusions — Dabigatran and warfarin were associated with similar rates of periprocedural bleeding , including patients having urgent surgery . Dabigatran facilitated a shorter interruption of oral anticoagulation . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00262600 OBJECTIVES This prospect i ve clinical comparative study aim ed to analyze the postoperative bleeding risk of patients continuing their anticoagulation therapy ( AT ) and undergoing implant surgery and bone grafting procedures . MATERIAL S AND METHODS The treatments ranged from the insertion of single or multiple dental implants over implant exposures to sinus floor augmentation and vertical and /or lateral bone grafting with autologous bone grafts . The patients of the test groups ( AT groups ) were treated with platelet aggregation inhibitors ( PAIs ) , Vitamin-K inhibitors , Vitamin-K inhibitor withdrawal bridged with heparin ( LMWH ) , or new/direct oral anticoagulants ( NOACs/DOACs ) .  Patients of the control group were non-anticoagulated ( non-AT group ) . Surgical procedures were performed in the same manner in all groups . Pre , intra , and postoperative data concerning the treatment , extent of the surgery and bleedings was recorded and statistically evaluated . RESULTS There were seven postoperative bleedings in 564 patients ( 1.2 % ) , four in the AT groups ( 3.4 % ) , and three in the non-AT group ( 0.6 % ) . No thromboembolic complication occurred in the whole observation period . The invasiveness of the surgical procedure had no statistically significant effect on bleeding frequencies .  Patients taking Vitamin-K inhibitors had a significantly higher risk of a postoperative bleeding compared to patients without any AT ( P = 0.038 ) . Two patients were hospitalized due to the severity of the bleeding as a pre caution ary measure ( one in the non-AT and one in the PAI group ) . All bleedings were easily controllable with local hemostatic measures . There was no postoperative bleeding recorded for patients taking DOACs . CONCLUSIONS Anticoagulation therapy should be continued in patients undergoing implant surgery and bone grafting procedures avoiding thromboembolic complications . Surgeons should always apply the most minimally invasive approach to reduce postoperative risks and be able to apply local hemostatic measures in terms of a bleeding complication PURPOSE To evaluate postoperative bleeding and thromboembolic complications during dental extraction s in anticoagulated patients , using 2 different protocol s. PATIENTS AND METHODS In total , 214 anticoagulated patients in need of simple dental extraction s were r and omized into 2 groups . Group A consisted of 109 patients on continuous oral anticoagulation therapy ( OAT ) , with a mean international normalized ratio ( INR ) of 2.45 + /- 0.54 . Local hemostasis in these patients was achieved with resorbable collagen sponges , without wound suturing . Group B consisted of 105 patients on bridging therapy with low-molecular-weight heparin ( nadroparin-calcium ) , with a mean INR of 1.26 + /- 0.11 on the day of the procedure . Neither local hemostatic agents nor suturing 
    Output:
    
Although none of the studies reported a thromboembolic event after interruption of anticoagulation , the follow-up periods were short and inconsistent , and the heightened thromboembolic risk when stopping anticoagulation is well known in the literature .
Heparin bridging was associated with an increased bleeding incidence .