Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Direct Oral Anticoagulant | Research

The Effect of Direct Oral Anticoagulant Therapy (DOACs) on oral surgical procedures: a systematic review

Author: Ghassan Darwish

Published in: BMC Oral Health | Issue 1/2023

Login to get access

Abstract

Background

Direct oral anticoagulants (DOACs) were developed to overcome the drawbacks of oral anticoagulants. However, not much has been discussed about the perioperative management of patients on DOACs during oral surgical procedures. Thus, we aim to determine the risk of perioperative and postoperative bleeding during oral surgical procedures in patients on DOACs.

Methods

A detailed literature search was performed to find potentially relevant studies using the Cochrane Library, Clinical Key, ClinicalTrials.gov, Google Scholar, Ovid, ScienceDirect, and Scopus. Every article available for free in English literature for the past 10 years, between 2012 and 2022, was searched.

Results

A total of 2792 abstracts were selected through a search strategy across various search engines. Based on inclusion and exclusion criteria, eleven clinical studies using DOACs as anticoagulants or studies comparing patients with and without DOACs under oral surgery procedures were found. The results were inconsistent and varied, with a few studies recommending DOAC administration with the bare minimum reported complications and others finding no statistically significant difference between discontinuation or continuation of drugs, especially across basic dental procedures.

Conclusion

Within the limitations of the study, it can be concluded that minor oral surgical procedures are safe for patients on DOAC therapy. However, the continuation or discontinuation of DOACs in patients undergoing oral surgical procedures remains controversial and requires further studies to extrapolate the results.
Appendix
Available only for authorised users
Literature
1.
De Caterina R. The current role of anticoagulants in cardiovascular medicine. J Cardiovasc Med (Hagerstown). 2009;10(8):595–604.CrossRefPubMed
2.
Madrid C, Sanz M. What influence do anticoagulants have on oral implant therapy? A systematic review. Clin Oral Implants Res. 2009;20(4):96–106.CrossRefPubMed
3.
Bajkin BV, Vujkov SB, Milekic BR, Vuckovic BA. Risk factors for bleeding after oral surgery in patients who continued using oral anticoagulant therapy. J Am Dent Assoc. 2015;146(6):375–81.CrossRefPubMed
4.
Cannon PD, Dharmar VT. Minor oral surgical procedures in patients on oral anticoagulants–a controlled study. Aust Dent J. 2003;48(2):115–8.CrossRefPubMed
5.
Andrade JG, Krahn AD, Skanes AC, Purdham D, Ciaccia A, Connors S. Values and preferences of physicians and patients with Nonvalvular atrial fibrillation who receive oral anticoagulation therapy for stroke prevention. Can J Cardiol. 2016;32(6):747–53.CrossRefPubMed
6.
Kammerer PW, Frerich B, Liese J, Schiegnitz E, Al-Nawas B. Oral surgery during therapy with anticoagulants – a systematic review. Clin Oral Invest. 2015;19:171–80.CrossRef
7.
Yang S, Shi Q, Liu J, Li J, Xu J. Should oral anticoagulant therapy be continued during dental extraction? A meta-analysis. BMC Oral Health. 2016;16(1):81.CrossRefPubMedPubMedCentral
8.
Bump RL, Kolodny SC. Fibrinolysis: a possible factor in the control of postoperative hemorrhage in the patient with hemophilia. Oral Surg Oral Med Oral Pathol. 1973;36(2):195–200.CrossRefPubMed
9.
Mulligan R, Weitzel KG. Pretreatment management of the patient receiving anticoagulant drugs. J Am Dent Assoc. 1988;117(3):479–83.CrossRefPubMed
10.
Wahl MJ. Myths of dental surgery in patients receiving anticoagulant therapy. J Am Dent Assoc. 2000;131(1):77–81.CrossRefPubMed
11.
António N, Castro G, Ramos D, et al. The debate concerning oral anticoagulation: whether to suspend oral anticoagulants during dental treatment. Rev Port Cardiol. 2008;27(4):531–44.PubMed
12.
13.
Dunn AS, Turpie AG. Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med. 2003;163(8):901–8.CrossRefPubMed
14.
Akopov SE, Suzuki S, Fredieu A, Kidwell CS, Saver JL, Cohen SN. Withdrawal of warfarin prior to a surgical procedure: time to follow the guidelines? Cerebrovasc Dis. 2005;19(5):337–42.CrossRefPubMed
15.
Garcia DA, Regan S, Henault LE, et al. Risk of thromboembolism with short-term interruption of warfarin therapy. Arch Intern Med. 2008;168(1):63–9.CrossRefPubMed
16.
Nathwani S, Wanis C. Novel oral anticoagulants and exodontia: the evidence. Br Dent J. 2017;222(8):623–8.CrossRefPubMed
17.
Bensi C, Belli S, Paradiso D, Lomurno G. Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2018;47(7):923–32.CrossRefPubMed
18.
Firriolo FJ, Hupp WS. Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(4):431–41.CrossRefPubMed
19.
Sairaku A, Yoshida Y, Ando M, Hirayama H, Nakano Y, Kihara Y. A head-to-head comparison of periprocedural coagulability under anticoagulation with rivaroxaban versus dabigatran in patients undergoing ablation of atrial fibrillation. Clin Drug Investig. 2013;33(11):847–53.CrossRefPubMed
20.
Nin T, Sairaku A, Yoshida Y, et al. A randomized controlled trial of dabigatran versus warfarin for periablation anticoagulation in patients undergoing ablation of atrial fibrillation. Pacing Clin Electrophysiol. 2013;36(2):172–9.CrossRefPubMed
21.
Dvorackova S, Mala-Ladova K, Zimcikova E, et al. Spontaneous reports of adverse drug reactions related to oral anticoagulants in the Czech Republic. Int J Clin Pharm. 2021;43(4):948–57.CrossRefPubMed
22.
Ziakas PD, Kourbeti IS, Poulou LS, Vlachogeorgos GS, Mylonakis E. Medicare part D prescribing for direct oral anticoagulants in the United States: Cost, use and the “rubber effect.” PLoS ONE. 2018;13(6):e0198674.CrossRefPubMedPubMedCentral
23.
Shah R, Patel MR. Primary and key secondary results from the ROCKET AF trial, and their implications on clinical practice. Ther Adv Cardiovasc Dis. 2017;11(3):105–20.CrossRefPubMed
24.
Costantinides F, Rizzo R, Pascazio L, Maglione M. Managing patients taking novel oral anticoagulants (NOAs) in dentistry: a discussion paper on clinical implications. BMC Oral Health. 2016;16:5 (Published 2016 Jan 28).CrossRefPubMedPubMedCentral
25.
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute. 2011;2(1):1–2.
26.
Hanken H, Gröbe A, Heiland M, Smeets R, Kluwe L, Wikner J, et al. Postoperative bleeding risk for oral surgery under continued rivaroxaban anticoagulant therapy. Clin Oral Investig. 2016;20(6):1279–82.CrossRefPubMed
27.
Miller SG, Miller CS. Direct oral anticoagulants: a retrospective study of bleeding, behavior, and documentation. Oral Dis. 2018;24(1–2):243–8.CrossRefPubMed
28.
Cocero N, Basso M, Grosso S, Carossa S. Direct oral anticoagulants and medical comorbidities in patients needing dental extractions: management of the risk of bleeding. J Oral Maxillofac Surg. 2019;77(3):463–70.CrossRefPubMed
29.
Kwak EJ, Nam S, Park KM, Kim SY, Huh J, Park W. Bleeding related to dental treatment in patients taking novel oral anticoagulants (NOACs): a retrospective study. Clin Oral Investig. 2019;23(1):477–84.CrossRefPubMed
30.
Kim T, Finkelman M, Desai B, Farag A. Direct-acting oral anti-coagulants in dental practice: a Retrospective Observational Study (Part 1). Oral Dis. 2021;27(4):1052–8.CrossRefPubMed
31.
Woolcombe SA, Ball RE, Patel JP. Managing direct oral anticoagulants in accordance with the Scottish Dental Clinical Effectiveness Programme guidance for patients undergoing dentoalveolar surgery. Br Dent J. 2022;232(8):547–54.CrossRefPubMedPubMedCentral
32.
Galletti G, Alfonsi F, Raffaele A, et al. Implant placement in patients under treatment with rivaroxaban: a retrospective clinical study. Int J Environ Res Public Health. 2020;17(12):4607 (Published 2020 Jun 26).CrossRefPubMedPubMedCentral
33.
Gómez-Moreno G, Fernández-Cejas E, Aguilar-Salvatierra A, de Carlos F, Delgado-Ruiz RA, Calvo-Guirado JL. Dental implant surgery in patients in treatment by dabigatran. Clin Oral Implants Res. 2018;29(6):644–8.CrossRefPubMed
34.
Miclotte I, Vanhaverbeke M, Agbaje JO, Legrand P, Vanassche T, Verhamme P, et al. Pragmatic approach to manage new oral anticoagulants in patients undergoing dental extractions: a prospective case-control study. Clin Oral Investig. 2017;21(7):2183–8.CrossRefPubMed
35.
Capparè P, Tetè G, Alfieri O, Pantaleo G, Montemezzi P. Postoperative bleeding in patients under direct oral anticoagulation after maxillary sinus floor augmentation: a case-control study. Int J Oral Maxillofac Implants. 2022;37(2):365–72.CrossRefPubMed
36.
Campbell JH, Alvarado F, Murray RA. Anticoagulation and minor oral surgery: should the anticoagulation regimen be altered? J Oral Maxillofac Surg. 2000;58(2):131–6.CrossRefPubMed
37.
Clemm R, Neukam FW, Rusche B, Bauersachs A, Musazada S, Schmitt CM. Management of anticoagulated patients in implant therapy: a clinical comparative study. Clin Oral Implant Res. 2016;27(10):1274–82.CrossRef
38.
39.
40.
41.
Daly C. Treating patients on new anticoagulant drugs. Austr Prescr. 2016;39:205–7.CrossRef
42.
Zeng S, Zheng Y, Jiang J, Ma J, Zhu W, Cai X. Effectiveness and Safety of DOACs vs Warfarin in Patients with Atrial Fibrillation and Frailty: A Systematic Review and Meta-Analysis. Front Cardiovasc Med. 2022;9:907197.CrossRefPubMedPubMedCentral
43.
44.
Lanau N, Mareque J, Giner L, Zabalza M. Direct oral anticoagulants and its implications in dentistry. A review of literature. J Clin Exp Dent. 2017;9(11):e1346–54.PubMedPubMedCentral
Metadata
Title
The Effect of Direct Oral Anticoagulant Therapy (DOACs) on oral surgical procedures: a systematic review
Author
Ghassan Darwish
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-03427-8

Other articles of this Issue 1/2023

BMC Oral Health 1/2023 Go to the issue

Research

Research efficacy of gaseous ozone therapy as an adjuvant to periodontal treatment on oxidative stress mediators in patients with type 2 diabetes: a randomized clinical trial

Research

Knowledge and attitude toward oral health behavior of overseas students during the COVID-19 pandemic

Case Report

Successful rehabilitation after multiple severe complications following orthognathic surgery: a case report

Research

Effect of lactobacillus reuteri-derived probiotic nano-formulation on recurrent aphthous stomatitis: a double-blinded randomized clinical trial

Case Report

Sick sinus syndrome diagnosed after a sinus arrest during treatment for zygomatic fracture: a case report

Research

Caries experience and risk indicators of having decayed teeth among 65-year-olds in Oslo, Norway: a cross-sectional study