Implant Placement in Patients under Treatment with Rivaroxaban: A Retrospective Clinical Study

Abstract

The management of patients under treatment with Direct Oral Anticoagulants (DOACs) has led clinicians to deal with two clinical issues, such as the hemorrhagic risk in case of non-interruption or the risk of thromboembolism in case of suspension of the treatment. The primary aim of this retrospective study was to evaluate the incidence of perioperative bleeding events and healing complications in patients who were under treatment with Rivaroxaban and who received dental implants and immediate prosthetic restoration. Patients treated with Rivaroxaban (Xarelto 20 mg daily) and who needed implant rehabilitation were selected. Four to six implants were placed in mandibular healed sites or fresh extraction sockets. All patients, in agreement with their physicians, interrupted the medication for 24 h and received implants and immediate restorations. Twelve patients and 57 implants were analyzed in the study. No major postoperative bleeding events were reported. Three patients (25%) presented slight immediate postoperative bleeding controlled with compression only. The implant and prosthetic survival rate were both 100% after 1 year. Within the limitations of this study, multiple implant placement with an immediate loading can be performed without any significant complication with a 24 h discontinuation of Rivaroxaban, in conjunction with the patient’s physician.

Patients Taking Direct Oral Anticoagulants (DOAC) Undergoing Oral Surgery: A Review of the Literature and a Proposal of a Peri-Operative Management Protocol

“…In the event of placement of a number greater than or equal to four implants, in a recent study in patients receiving rivaroxaban, the DOAC was suspended 24 h before surgery. In this study, only three minor bleeding events treated with compression were observed out of 12 treated patients and 57 placed implants [49].…”

Dental implants and risk of bleeding in patients on oral anticoagulants: a systematic review and meta-analysis

“…Full texts of 12 articles were obtained for further assessment, resulting in exclusion of a further 4 studies. Finally, 8 studies [6,[11][12][13][14][15][16][17] met eligibility criteria for this review and were included for full analysis (Fig. 1).…”

“…All articles included were observational cohort studies. There were 4 retrospective [6,11,12,17] and 4 prospective [13][14][15][16]; of the prospective studies, 3 [13,14,16] blinded the operator from which patients were taking anticoagulants. A total of 1467 participants were included with a minimum of 2366 implants placed across all studies.…”

“…In order to minimise clinical heterogeneity with study protocols, the analysis was split into two subgroups. The studies were split dependant upon their peri-operative protocols in which one group (1) continued anticoagulation perioperatively without a pause [6,12,13,[15][16][17] and those which (2) discontinued in the immediate pre-operative period [11,14] and restarted 6-12 h post-operatively.…”

“…One study [6] required patients to self-report bleeding and of those who required urgent clinical assessment, the bleeding was quantified subjectively. Four studies [11,13,14,16] analysed bleeding in accordance to criteria set out by Bacci et al [16] which categorises bleeding complications into four stages with escalating levels of haemostatic control. One [12] study qualified bleeding within 24 h as a primary outcome measure with anything > 24 h considered a secondary outcome with associated features of haematoma, purpura or ecchymoses.…”