Top

Published in:

01-12-2017 | Original Article

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

Authors: Takumi Hasegawa, Souichi Yanamoto, Akira Tachibana, Yuka Kojima, Yoshito Koyama, Michinori Maeda, Takahide Komori, Japanese Study Group of Cooperative Dentistry with Medicine (JCDM)

Published in: Oral and Maxillofacial Surgery | Issue 4/2017

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.

Ziffer AM, Scopp IW, Beck J, Baum J, Berger AR (1957) Profound bleeding after dental extractions during dicumarol therapy. N Engl J Med 256:351–353CrossRefPubMed

Scopp IW, Fredrics H (1958) Dental extractions in patients undergoing anticoagulant therapy. Oral Surg Oral Med Oral Pathol 11:470–474CrossRefPubMed

Spouge JD (1964) Hemostasis in dentistry, with special reference to hemocoagulation. 3. Principles underlying clinical hemostatic practices in patients with faulty coagulation. Oral Surg Oral Med Oral Pathol. 18:701–712CrossRefPubMed

Kearon C, Hirsh J (1997) Management of anticoagulation before and after elective surgery. N Engl J Med 336:1506–1511CrossRefPubMed

Albers G, Dalen JE, Laupacis A, Manning WJ, Petersen P, Singer DE (2001) Antithrombotic therapy in atrial fibrillation. Chest 119(1 Suppl):194S–206SCrossRefPubMed

Büller HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE (2004) Antithrombotic therapy for venous thromboembolic disease: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126(3 Suppl):401S–428SCrossRefPubMed

Salem DN, Stein PD, Al-Ahmad A, Bussey HI, Horstkotte D, Miller N et al (2004) Antithrombotic therapy in valvular heart disease—native and prosthetic: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126(3 Suppl):457S–482SCrossRefPubMed

Wahl MJ (2000) Myths of dental surgery in patients receiving anticoagulant therapy. J Am Dent Assoc 131(1):77–81CrossRefPubMed

Blacker DJ, Wijdicks EF, McClelland RL (2003) Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy. Neurology 61(7):964–968CrossRefPubMed

10.

Devani P, Lavery KM, Howell CJ (1998) Dental extractions in patients on warfarin: is alteration of anticoagulant regime necessary? Br J Oral Maxillofac Surg 36(2):107–111CrossRefPubMed

11.

Blinder D, Manor Y, Martinowitz U, Taicher S (2001) Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding. Int J Oral Maxillofac Surg 30(6):518–521CrossRefPubMed

12.

Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW (2002) Can warfarin be continued during dental extraction? Results of a randomized controlled trial. Br J Oral Maxillofac Surg 40(3):248–252CrossRefPubMed

13.

Sacco R, Sacco M, Carpenedo M, Mannucci PM (2007) Oral surgery in patients on oral anticoagulant therapy: a randomized comparison of different intensity targets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104(1):e18–e21CrossRefPubMed

14.

Al-Mubarak S, Al-Ali N, Abou-Rass M, Al-Sohail A, Robert A, Al-Zoman K, Al-Suwyed A, Ciancio S (2007) Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy. Br Dent J 203(7):E15 discussion 410-1CrossRefPubMed

15.

Salam S, Yusuf H, Milosevic A (2007) Bleeding after dental extractions in patients taking warfarin. Br J Oral Maxillofac Surg 45(6):463–466CrossRefPubMed

16.

Perry DJ, Noakes TJ, Helliwell PS, British Dental Society (2007) Guidelines for the management of patients on oral anticoagulants requiring dental surgery. Br Dent J 203(7):389–393CrossRefPubMed

17.

Aframian DJ, Lalla RV, Peterson DE (2007) Management of dental patients taking common hemostasis-altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(Suppl):S45.e1–S45.11

18.

Ferrieri GB, Castiglioni S, Carmagnola D, Cargnel M, Strohmenger L, Abati S (2007 Jun) Oral surgery in patients on anticoagulant treatment without therapy interruption. J Oral Maxillofac Surg 65(6):1149–1154CrossRefPubMed

19.

Nematullah A, Alabousi A, Blanas N, Douketis JD, Sutherland SE (2009) Dental surgery for patients on anticoagulant therapy with warfarin: a systematic review and meta-analysis. J Can Dent Assoc 75(1):41PubMed

20.

Scully C, Wolff A (2002) Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 94(1):57–64CrossRefPubMed

21.

Bodner L, Weinstein JM, Baumgarten AK (1998) Efficacy of fibrin sealant in patients on various levels of oral anticoagulant undergoing oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86(4):421–424CrossRefPubMed

22.

Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY (2010) A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in atrial fibrillation patients: the Euro Heart Survey. Chest 138:1093–1100CrossRefPubMed

23.

Morimoto Y, Niwa H, Minematsu K (2012) Risk factors affecting hemorrhage after tooth extraction in patients undergoing continuous infusion with unfractionated heparin. J Oral Maxillofac Surg 70(3):521–526CrossRefPubMed

24.

Borea G, Montebugnoli L, Capuzzi P, Magelli C (1993) Tranexamic acid as a mouthwash in anticoagulant-treated patients undergoing oral surgery. An alternative method to discontinuing anticoagulant therapy. Oral Surg Oral Med Oral Pathol 75(1):29–31CrossRefPubMed

25.

Bajkin BV, Vujkov SB, Milekic BR, Vuckovic BA (2015) Risk factors for bleeding after oral surgery in patients who continued using oral anticoagulant therapy. J Am Dent Assoc. 146(6):375–381CrossRefPubMed

26.

Iwabuchi H, Imai Y, Asanami S, Shirakawa M, Yamane GY, Ogiuchi H, Kurashina K, Miyata M, Nakao H, Imai H (2014) Evaluation of postextraction bleeding incidence to compare patients receiving and not receiving warfarin therapy: a cross-sectional, multicentre, observational study. BMJ Open 4(12):e005777CrossRefPubMedPubMedCentral

27.

Nakatani S, Mitsutake K, Hozumi T, Yoshikawa J, Akiyama M, Yoshida K, Ishizuka N, Nakamura K, Taniguchi Y, Yoshioka K, Kawazoe K, Akaishi M, Niwa K, Nakazawa M, Kitamura S, Miyatake K, Committee on Guideline for Prevention and Management of Infective Endocarditis, Japanese Circulation Society (2003) Current characteristics of infective endocarditis in Japan: an analysis of 848 cases in 2000 and 2001. Circ J 67(11):901–905CrossRefPubMed

28.

Murasaki K (2011) Guidelines for management of anticoagulant and antiplatelet therapy in cardiovascular disease (JCS 2009). Nihon Rinsho 69(Suppl 9):567–571PubMed

29.

Abdullah WA, Khalil H (2014) Dental extraction in patients on warfarin treatment. Clin Cosmet Investig Dent 6:65–69PubMedPubMedCentral

30.

Randall C (2005) Surgical management of the primary care dental patient on warfarin. Dent Update 32:414–420 423CrossRefPubMed

31.

Barrett D (2004) Management of dental patients on warfarin therapy in a primary care setting. Dent Update 31:618PubMed

32.

Carter G, Goss A, Lloyd J, Tocchetti R (2003) Tranexamic acid mouthwash versus autologous fibrin glue in patients taking warfarin undergoing dental extractions: a randomized prospective clinical study. J Oral Maxillofac Surg 61:1432–1435CrossRefPubMed

33.

Carter G, Goss AN, Lloyd J, Tocchetti R (2003) Current concepts of the management of dental extractions for patients taking warfarin. Aust Dent J 48:89–96CrossRefPubMed

34.

Cocero N, Mozzati M, Ambrogio M, Bisi M, Morello M, Bergamasco L (2014) Bleeding rate during oral surgery of oral anticoagulant therapy patients with associated systemic pathologic entities: a prospective study of more than 500 extractions. J Oral Maxillofac Surg 72:858–867CrossRefPubMed

35.

Black JA (1994) Diarrhoea, vitamin K, and warfarin. Lancet 344(8933):1373CrossRefPubMed

36.

Smith JK, Aljazairi A, Fuller SH (1999) INR elevation associated with diarrhea in a patient receiving warfarin. Ann Pharmacother 33(3):301–304CrossRefPubMed

37.

Hylek EM, Heiman H, Skates SJ, Sheehan MA, Singer DE (1998) Acetaminophen and other risk factors for excessive warfarin anticoagulation. JAMA 279(9):657–662CrossRefPubMed

38.

Toyoda K, Yasaka M, Iwade K, Nagata K, Koretsune Y, Sakamoto T, Uchiyama S, Gotoh J, Nagao T, Yamamoto M, Takahashi JC, Minematsu K, Bleeding with Antithrombotic Therapy (BAT) Study Group (2008) Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease—a prospective, multicenter, observational study. Stroke 39:1740CrossRefPubMed

39.

Cox SR, VanderLugt JT, Gumbleton TJ, Smith RB (1987) Relationships between thromboxane production, platelet aggregability, and serum concentrations of ibuprofen or flurbiprofen. Clin Pharmacol Ther 41(5):510–521CrossRefPubMed

40.

Silverstein FE, Faich G, Goldstein JL, Simon LS, Pincus T, Whelton A, Makuch R, Eisen G, Agrawal NM, Stenson WF, Burr AM, Zhao WW, Kent JD, Lefkowith JB, Verburg KM, Geis GS (2000) Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 284(10):1247–1255CrossRefPubMed

41.

Shorr RI, Ray WA, Daugherty JR, Griffin MR (1993) Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease. Arch Intern Med 153(14):1665–1670CrossRefPubMed

42.

Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW (1996) Amoxicillin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82(6):610–612CrossRefPubMed

43.

Mailloux AT, Gidal BE, Sorkness CA (1996 Dec) Potential interaction between warfarin and dicloxacillin. Ann Pharmacother 30(12):1402–1407CrossRefPubMed

Title: The risk factors associated with postoperative hemorrhage after tooth extraction: a multi-center retrospective study of patients receiving oral antithrombotic therapy
Authors: Takumi Hasegawa
Souichi Yanamoto
Akira Tachibana
Yuka Kojima
Yoshito Koyama
Michinori Maeda
Takahide Komori
Japanese Study Group of Cooperative Dentistry with Medicine (JCDM)
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Oral and Maxillofacial Surgery / Issue 4/2017
Print ISSN: 1865-1550
Electronic ISSN: 1865-1569
DOI: https://doi.org/10.1007/s10006-017-0645-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2017

Comparison of 3D plate and locking plate in treatment of mandibular fracture—a clinical study

Maxillary zygomatic hexagonal implant system (MZH system) for severe resorption: a new technique

A case of traumatic infraorbital neuroma

Surgical treatment of painful inferior alveolar nerve injuries following endodontic treatment: a consecutive case series of seven patients

Radiographic evaluation of condylar positioning in patients undergoing orthognathic surgery

The hydroxyapatite Turkish Delight: a technical note