Risks of postextraction bleeding after receiving direct oral anticoagulants or warfarin: a retrospective cohort study

Abstract

ObjectiveThe effect of direct oral anticoagulants (DOACs) on the risk of bleeding after tooth extraction remains unclear. This study aimed to evaluate the incidence of postextraction bleeding among patients who received DOAC and vitamin K antagonists (VKAs), such as warfarin.DesignThis study was a retrospective cohort analysis. Incidence rates and propensity score-matched regression models were used to compare the risks of bleeding after tooth extractions involving DOACs and VKAs.SettingThe study took place in a single university hospital in Japan.ParticipantsBetween April 2013 and April 2015, 543 patients underwent a total of 1196 simple tooth extractions.Primary outcome measureThe primary outcome measure was the occurrence of postextraction bleeding, which was defined as bleeding that could not be stopped by biting down on gauze and required medical treatment between 30 min and 7 days after the extraction.ResultsA total of 1196 tooth extractions (634 procedures) in 541 patients fulfilled the study criteria, with 72 extractions (41 procedures) involving DOACs, 100 extractions (50 procedures) involving VKAs and 1024 extractions (543 procedures) involving no anticoagulants. The incidences of postextraction bleeding per tooth for the DOAC, VKA and no anticoagulant extractions were 10.4%, 12.0% and 0.9%, respectively. The incidences of postextraction bleeding per procedure for DOACs, VKAs and no anticoagulants were 9.7%, 10.0% and 1.1%, respectively. In comparison to the VKA extractions, the DOAC extractions did not significantly increase the risk of postextraction bleeding (OR 0.69, 95% CIs 0.24 to 1.97; p=0.49).ConclusionsThe risk of postextraction bleeding was similar for DOAC and VKA extractions.

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

“…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).…”

“…Johnston, 2015;Kwak et al, 2018;Lababidi et al, 2018;Miller & Miller, 2018;Patel et al, 2017;Zeevi et al, 2017) and two caseseries studies(Breik et al, 2014 andHassona et al, 2018) 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, 2016;Gómez-Moreno et al, 2018;Miclotte et al, 2017) or who continued it unchanged(Andrade et al, 2018;Berton et al, 2018;Caliskan et al, 2017;Clemm et al, 2016;Gómez-Moreno et al, 2016;Hanken et al, 2016;Mauprivez et al, 2016;Miranda et al, 2016;Morimoto et al, 2016;Yagyuu et al, 2017). The majority of these 13 studies compared patients taking DOAC therapy with healthy patients not taking any anticoagulation therapies or with patients treated with VKAs.…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…370,374,375 There is strong evidence that the cessation of anticoagulation drug treatment for surgical procedures increases the patients' risk for potentially lethal cardiovascular events, 375,376 whereas postoperative bleeding complicationsdif they occur at alldcan mostly be controlled with rather limited local measures (occluding on gauze, hemostyptics, sutures, antifibrionlytic agents). Therefore, it is recommended that oral surgical procedures with no or limited risk of postoperative bleeding should be carried out under continued anticoagulant therapy 370,[373][374][375] if all local measures of hemostasis are applied. The latest literature states that this approach is advised regardless of the prescribed anticoagulative agent (either vitamin K antagonists or NOACs).…”

Neue orale Antikoagulanzien

“…Ein 4-Punkte-Score zur Charakterisierung der Leberfunktion dient der Einschätzung des Blutungsrisikos bei Anwendung von Vitamin-K-Antagonisten. Bezüglich der Blutungen nach zahnärztlichen Eingriffen konnten zwischen den Vitamin-K-Antagonisten und den direkten oralen Antikoagulanzien keine signifikanten Unterschiede festgestellt werden [5].…”