The risk factors associated with postoperative hemorrhage after tooth extraction: a multi-center retrospective study of patients receiving oral antithrombotic therapy

Abstract

The purpose of this study was to retrospectively investigate the multivariate relationships between specific risk factors and postoperative hemorrhage after tooth extraction in patients who were prescribed oral antithrombotic therapy. Risk factors for postoperative hemorrhage after tooth extraction were evaluated using univariate and multivariate analyses. Patient characteristics such as age and gender; the presence or absence of known comorbidities such as diabetes mellitus, hypertension, cerebral infarction, and alcohol consumption; and perioperative diarrhea were assessed. The drug used for antithrombotic therapy, preoperative blood test results, the presence or absence of preoperative antibiotics or nonsteroidal anti-inflammatory drug (NSAID) administration, the total number of extracted teeth, and the type of surgical procedures were also evaluated. We found that the preoperative administration of antibiotics (odds ratio (OR) = 2.52), an increased prothrombin time international normalized ratio (PT-INR) value (OR = 1.94), and the extraction of multiple teeth (OR = 2.10) were significantly associated with postoperative hemorrhage. There was no significant association between postoperative hemorrhage and any other demographic factors or comorbidities, including concomitant alcohol use. We demonstrated the multivariate relationship between the risk factors and postoperative hemorrhage after tooth extraction in patients receiving oral antithrombotic therapy. Surgeons should be aware of these risks and monitor the PT-INR of anticoagulated patients.

Tooth extraction without discontinuation of oral antithrombotic treatment: A prospective study

“…The main feature of the present study is the low incidence of The second important descriptive aspect of the present study is the high mean age of the patient sample (74.26 ± 9.83) which is the highest in the consulted literature although some studies have only slightly lower values (Cocero et al, 2014;Hasegawa et al, 2017;Lababidi et al, 2018;Yanamoto et al, 2017).…”

Salivary tissue factor induces thrombin generation in a diurnal rhythm

“…During the day, toothbrushing and food intake are known to alter the composition of the oral biofilm compared to the night, during which the low saliva flow creates a hospitable environment for, amongst others, streptococci 25, 26. In support of this hypothesis, a previous study reported that the use of prophylactic antibiotics prior to tooth extraction was independently associated with a higher risk of postoperative bleeding 6. Therefore, it would be interesting to assess a possible relation between salivary TF concentration and bacterial status in the oral cavity.…”

“…25,26 In support of this hypothesis, a previous study reported that the use of prophylactic antibiotics prior to tooth extraction was independently associated with a higher risk of postoperative bleeding. 6 Therefore, it would be interesting to assess a possible relation between salivary TF concentration and bacterial status in the oral cavity.…”

“…5 TF in saliva is bound to the membrane of exosomes released from epithelial cells. 5 Since the duration of postextraction bleeding is highly variable between patients, we hypothesized that, besides the influence of blood-borne coagulation factor levels, comorbidities, and medication, 6 there may be variation in salivary TF-induced clotting activity. To obtain more mechanistic insight into the procoagulant effect of saliva, we measured thrombin generation (TG).…”

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

“…40 Se ha demostrado que no existe una diferencia significativa en la tasa de sangrado en los grupos ACDO, 41 pero Cocero et al (2019) llegaron a la conclusión de que el sangrado excesivo en pacientes que toman ACDO se da por no respetar un intervalo entre la última ingesta y el momento de la cirugía, de al menos 4 a 6 horas y debe evitarse la extracción de dos o tres piezas contiguas en la misma cita (premolares y molares). 42,43 El sangrado posoperatorio está relacionado con la extracción de múltiples piezas dentales en una sola cita, 44 por lo tanto, si se desea extraer más dientes, se debe realizar interconsulta con el médico especialista para determinar el riesgo y beneficio de la intervención. 45 Andrade et al (2018 ) encontraron que en los pacientes que consumen Dabigatrán presentan mayor frecuencia de sangrado 24 horas después de la extracción dental.…”