Risk factors associated with post-extraction bleeding in patients on warfarin or direct-acting oral anticoagulants: a retrospective cohort study

Abstract

The purpose of this study was to investigate the risk factors associated with postextraction persistent bleeding in patients on warfarin or direct-acting oral anticoagulants (DOACs) and the ability of risk scores to predict post-extraction bleeding. Methods 391 patients taking warfarin or DOACs underwent tooth extractions. Various risk factors for post-extraction bleeding, including number of tooth extraction, with antiplatelet therapy, and risk scores, were investigated by univariate and multivariate analyses. A post-extraction bleeding was classified into Grade 1-3. Results The incidence of post-extraction bleeding was 26.8% (77 out of 287 patients; Grade 1: 63, Grade 2:14) in patients taking warfarin, and 26.0% (27 out of 104 patients; Grade 1: 20, Grade 2:7) in patients taking warfarin DOACs. Multivariate analyses showed that multiple teeth extractions and HAS-BLED scores (above 3 points) in patients taking warfarin, and only multiple teeth extractions in patients taking DOAC, were significantly associated with post-extraction bleeding, respectively. Conclusion Most of the post-extraction bleedings were Grade 1, which can be stopped by eligibly pressing gauze by surgeons. If patients taking anticoagulants are scheduled to undergo multiple teeth extractions or their HAS-BLED score are above 3 points (if warfarin), we recommend informing patients risk of post-extraction bleeding before operation, taking carefully hemostasis, and instruction patients to bite down accurately on the gauze for longer than usual.

A natural polyphenol-functionalized chitosan/gelatin sponge for accelerating hemostasis and infected wound healing

“…15 After tooth exaction, soft tissue tearing, granulation tissue remnant, vascular rupture, and alveolar process fracture can induce TEB. 16 A reasonable selection and local application of hemostatic materials/devices are the main strategy to prevent/treat TEB and decrease the pain of the patients. 17 Notably, the oral cavity is an open bacterial environment and tooth extraction is an invasive surgical operation, which can easily lead to oral wound infection/infectious inflammation after tooth extraction.…”

The Effectiveness and Safety of Autologous Platelet Concentrates as Hemostatic Agents after Tooth Extraction in Patients on Anticoagulant Therapy: A Systematic Review of Randomized, Controlled Trials

“…Furthermore, it must be taken into account that patient factors, such as the presence of comorbidities and vicious habits, may influence post-operative bleeding and wound healing [ 66 ]. Only Brancaccio et al considered vicious habits (cigarette smoking) and comorbidities (hypertension and diabetes) which can increase the likelihood of bleeding and delayed wound healing beyond 30 min post-operatively.…”

An injectable and coagulation-independent Tetra-PEG hydrogel bioadhesive for post-extraction hemostasis and alveolar bone regeneration

“…Moreover, unexpected post-extraction bleeding arising from local and systemic factors is frequently encountered (i.e., up to 26% incidence), which is often challenging to manage with the existing hemostatic agents [ 8 , 9 ]. These situations become more urgent and life-threatening for patients on long-term anticoagulant therapy, especially considering that dental surgeries are nowadays recommended to be carried out without reducing or discontinuing anticoagulant therapy to prevent the recurrence of thromboembolism [ 10 , 11 ]. As a result, developing new strategies for socket wound care to offer rapid and coagulation-independent hemostatic sealing is highly desirable but remains a critical challenge.…”