Bleeding related to dental treatment in patients taking novel oral anticoagulants (NOACs): a retrospective study

Abstract

Our study suggests that patients taking NOACs who need dental treatments may have a bleeding tendency based on our retrospective data. Preoperative history taking and treatment modification should therefore be considered before performing dental surgery.

World workshop on oral medicine VII: Direct anticoagulant agents management for invasive oral procedures: A systematic review and meta‐analysis

“…Although 21 studies were included in the review, only six studies (Johnston, ; Kwak et al., ; Lababidi et al., ; Miller & Miller, ; Patel et al., ; Zeevi et al., ) and two case‐series studies (Breik et al., and Hassona et al., ) reported on a direct comparison between these two groups of patients. The remaining 13 articles analyzed bleeding events in patients who had all discontinued DOAC therapy before surgery (Abayon et al., ; Gómez‐Moreno et al., ; Miclotte et al., ) or who continued it unchanged (Andrade et al., ; Berton et al., ; Caliskan et al., ; Clemm et al., ; Gómez‐Moreno et al., ; Hanken et al., ; Mauprivez et al., ; Miranda et al., ; Morimoto et al., ; Yagyuu et al., ).…”

“…Of the six studies, one study was assessed as good quality, four were evaluated as fair quality, and one of poor quality (Table ). Risk of bias of the 21 studies was assessed using the Newcastle‐Ottawa scale: two studies received a low risk of bias score (seven stars, Miller & Miller, ; Zeevi et al., ), 16 studies received a high risk of bias score (six stars, Andrade et al., ; Berton et al., ; Caliskan et al., ; Clemm et al., ; Gómez‐Moreno et al., , ; Hanken et al., ; Kwak et al., ; Lababidi et al., ; Mauprivez et al., ; Miclotte et al., ; Miranda et al., ; Morimoto et al., ; Patel et al., ; Yagyuu et al., and five stars, Johnston, ), and three case‐series received a very high risk of bias score (one star, Abayon et al., ; Breik et al., ; Hassona et al., ; Table ).…”

“…None of the included studies was a randomized controlled trial (RCT). Nine articles were prospective case-control studies (Andrade et al, 2018;Berton et al, 2018;Caliskan, Tükel, Benlidayi, & Deniz, 2017;Clemm et al, 2016;Gómez-Moreno et al, 2016Mauprivez et al, 2016;Miclotte et al, 2017;Miranda et al, 2016), four were retrospective case-control studies (Hanken et al, 2016;Kwak et al, 2018;Lababidi et al, 2018;Yagyuu et al, 2017), and five studies were retrospective (Johnston, 2015;Miller & Miller, 2018;Morimoto, Yokoe, Imai, Sugihara, & Futatsuki, 2016;Zeevi et al, 2017) and prospective (Patel et al, 2017) observational studies, reporting data from medical records. Three studies were case-series (Abayon, Kolokythas, Siu, & Elad, 2016;Breik, Cheng, Sambrook, & Goss, 2014;Hassona, Malamos, Shaqman, Baqain, & Scully, 2018).…”

Periodontitis and cardiovascular diseases: Consensus report

“…It appears there is no need for interruption of NOAC therapy in most dental treatments, due to a low incidence of bleeding complications, which can be successfully managed with local haemostatic measures when comparing groups continuing NOAC and groups discontinuing NOAC therapy (Kwak et al, ; Lababidi et al, ; Patel et al, ; Yagyuu et al, ) and with reported timing of discontinuation and reinstitution varying greatly. When comparing NOAC patients with healthy individuals, there seems to be a higher incidence of delayed bleeding (2 days and later) in those patients who do not discontinue NOAC therapy (Miclotte et al, ).…”

Periodontitis and Cardiovascular Diseases. Consensus Report

“…It appears there is no need for interruption of NOAC therapy in most dental treatments due to a low incidence of bleeding complications, which can be successfully managed with local haemostatic measures when comparing groups continuing NOAC and groups discontinuing NOAC therapy [58,59,92,137], and with reported timing of discontinuation and reinstitution varying greatly. When comparing NOAC patients with healthy individuals, there seems to be a higher incidence of delayed bleeding (2 days and later) in those patients who do not discontinue NOAC therapy [78].…”