Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis

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

“…Furthermore, there is a wide heterogeneity between the 21 studies, in terms of DOAC treatment (most studies reported data on dabigatran and rivaroxaban, which have long been available), timing of discontinuation or continuation of the therapy, type of invasive oral procedures performed, and local intra‐operative hemostatic measures used to control bleeding. As reported by other authors (Bensi et al., ), it is also difficult to quantify and compare the POBE between studies, because there is no clear and standardized definition in the literature of minor versus moderate versus severe bleeding following invasive oral procedures.…”

“…Although for VKAs there is strong consensus that VKAs should not be interrupted for routine oral surgical procedures (AAOM, 2016), the same consensus is lacking for DOACs (Miller, 2018). However, the advantage of VKA therapy is the ability to determine an INR (international normalized ratio) evaluation to assess a patients' risk for bleeding (Manfredi, 2018 (Miller, 2018;Wahl, 2018 As reported by other authors (Bensi et al, 2018), it is also difficult to quantify and compare the POBE between studies, because there is no clear and standardized definition in the literature of minor versus moderate versus severe bleeding following invasive oral procedures.…”

“…In the past 5 years, several studies, position papers, and systematic reviews have been published on this topic (Bensi et al., ; Elad et al., ; Lusk, Snoga, Benitez, & Sarbacker, ; Miller, ; Shi et al., ; Wahl, ) reflecting the need to have practical guidelines for dental practitioners who manage the increasing number of patients taking DOACs. While it is likely that patients treated with anticoagulant drugs (DOACs and VKAs) may have more POBE after invasive oral procedures than patients who do not use these agents (Bensi et al., ; Shi et al., ), it is important to assess whether the consequences of bleeding events are more dire than the risk for a thromboembolic event, which may occur if these medications are suspended. Although for VKAs there is strong consensus that VKAs should not be interrupted for routine oral surgical procedures (AAOM, ), the same consensus is lacking for DOACs (Miller, ).…”

“…DOACs are increasingly used as an alternative to vitamin K antagonists (VKAs), such as warfarin, because they have several reported advantages, including rapid onset of action, short half‐lives, less drug–drug interactions, and no requirement for routine laboratory monitoring (Bauer, ). DOACs are used widely throughout the world, and there are numerous studies in the literature regarding dental management of patients taking these agents (Bensi, Belli, Paradiso, & Lomurno, ; Elad, Marshall, Meyerowitz, & Connolly, ; Shi, Xu, Zhang, Zhang, & Liu, ). Despite this, there is a lack of clarity regarding the consequences of discontinuing DOAC therapy prior to invasive oral procedures.…”

Manejo De La Extracción Dental en Pacientes Sometidos a Terapia Anticoagulante: Una Revisión De La Literatura

“…[3][4][5][6] Los anticoagulantes orales se clasifican según su mecanismo de acción en Antagonistas de la vitamina K (AVK), Inhibidores directos de la trombina e inhibidores directos del factor Xa, estos dos últimos conocidos como anticoagulantes directos orales (ACDO). 4,[6][7][8] Los AVK actúan inhibiendo los factores de coagulación dependientes de la vitamina K (II, VII, IX, X), dentro de este grupo se encuentra la warfarina y el acenocumarol6. Estos se caracterizan por tener un inicio de acción lento, su efecto tarda de 5 a 7 días en ser establecido, por lo tanto, se necesita de un puente inicial con heparina.…”