Dialysis & Oral Surgery
The degree to which kidney, liver & bone marrow disease interfere with coagulation following oral surgical procedures is not well understood. Although there are no randomised, prospective studies, it is unlikely that individuals whose kidney failure is well managed with dialysis would be at increased risk for clinically significant bleeding, even from multiple dental extractions.
In the case of dialysis for Chronic Renal Failure, patients are heparinised for the time they are receiving dialysis, & they could be anti-coagulated to some degree for several hours thereafter.
Heparinisation, along with chronic anti-coagulation (eg aspirin, warfarin), creates a multi factorial coagulopathy that puts a patient at higher risk for bleeding from oral surgical procedures immediately following dialysis. Although the half-life of heparin is approximately 4 hours, dialysis is a long & fatiguing procedure, & for this reason patients are better able to tolerate dental care on a non-dialysis day. On the other hand, the longer a patient is from their last dialysis, the more likely they are to have a coagulopathy from uræmia.
Useful Articles & Websites
Med Oral Patol Oral Cir Bucal 2008. Dental Management in Renal Failure – Patients on Dialysis