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

Abstract

Objectives This systematic review aimed to evaluate the current literature regarding the importance of discontinuing or not discontinuing direct oral anticoagulants (DOACs) before invasive oral procedures, and to establish the frequency and type of postoperative bleeding events in patients. Material and Methods We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up until November 5, 2018. Selection of the studies, extraction of data, qualitative, and bias assessment was performed independently by two authors. Results Twenty‐one studies were included. No randomized controlled studies were identified. Six studies reported a direct comparison between patients taking DOACs and those who discontinued DOACs. The meta‐analysis of these studies resulted in an OR of 0.92 (95% CI = 0.37–2.27, I2 = 9%) for postoperative bleeding events for patients taking DOACs. We found that 59/497 (11.8%) postoperative bleeding events occurred in patients who continued DOACs, while 27/200 (13.5%) events were reported for patients who discontinued treatment. All postoperative bleeding events were controlled with local measures. Conclusion Results from the included studies did not discern any important differences in postoperative bleeding events in patients who continued versus patients who discontinued DOACs. Furthermore, no thromboembolic events were recorded. However, the low quality of the studies must be considered.

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

“…Similarly to the studies of Lababidi et al (2018), Mauprivez et al (2016), andLu et al (2018), none of these treatments were found to be significantly related to the risk of bleeding. This is in line with all international guidelines and reviews on the safety of tooth extractions in this kind of patients, without interruption of oral antithrombotic treatment (Aframinan et al, 2007;Dézsi et al, 2017;van Diermen et al, 2009;Douketis et al, 2012;Elad et al, 2016;Manfredi et al, 2019;Scully & Wolff, 2002;Wahl, 2014).…”

Bleeding Complications in Anticoagulated and/or Antiplatelet-Treated Patients at the Dental Office: A Retrospective Study

“…They present a more direct and selective way of action. However, unlike the old anticoagulants, they do not have a specific monitoring test to evaluate their effect [4][5][6]. We find anticoagulants such as dabigatran, with renal elimination, contraindicated in severe renal impairment [1,4].…”

“…Due to the appearance of new antiplatelet agents/anticoagulants, the knowledge of the potential hemorrhagic and/or thrombotic effects that may occur at the dental office is a matter of interest [1][2][3][4][5][6][7][8]. Accordingly, the aim of the present retrospective study was to evaluate bleeding complications in anticoagulated and antiplatelet-treated patients during simple dental extractions in a period of 4 years.…”

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.…”

“…Los inhibidores directos de la trombina como el Dabigatrán y los inhibidores directos del factor Xa son el Rivaroxaban, Apixabán, Edoxabán y el Betrixabán. 4,8,13,14 En los últimos tiempos, los pacientes que reciben terapia anticoagulante han aumentado, por lo tanto, en odontología es permitido el manejo bajo ciertas condiciones en las diferentes áreas, así tenemos que en cirugía oral es posible realizar una extracción dental de manera segura, 3,15,16 teniendo en cuenta los efectos secundarios de los fármacos como una posible hemorragia post-extracción o en el caso de suspender el fármaco, la formación de un tromboembolismo. 15,17 El presente estudio tiene como objetivo analizar mediante una revisión de la literatura el tipo de manejo que necesita un paciente anticoagulado, además de las limitaciones, indicaciones y medidas hemostáticas que debemos tomar en cuenta al momento de realizar una extracción dental en estos pacientes.…”