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BMC Oral Health
Published in: BMC Oral Health 1/2021

Open Access 01-12-2021 | Tooth Extraction | Research

A prospective comparative study to assess the risk of postoperative bleeding after dental surgery while on medication with direct oral anticoagulants, antiplatelet agents, or vitamin K antagonists

Authors: Mayte Buchbender, Nicola Schlee, Marco R. Kesting, Jannik Grimm, Jakob Fehlhofer, Andrea Rau

Published in: BMC Oral Health | Issue 1/2021

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Abstract

Background

The aim of this prospective study was to investigate the occurrence and severity of postoperative bleeding following dentoalveolar surgery in patients with uninterrupted anticoagulation therapy (AT).

Methods

Patients receiving AT (vitamin k antagonist (VK), direct oral anticoagulants (DOAC) or antiplatelet therapy (APT) and in need of surgical intervention classified as A, B or C (single or serial tooth extraction, osteotomy, or implant placement) were studied between 2019 and 2021. A healthy, non-anticoagulated cohort (CG) served as a control group. The main outcomes measured were the frequency of postoperative bleeding, the classification of the severity of postoperative bleeding (1a, 1b, 1c, 2, 3), and the correlation with the AT surgical intervention classification.

Results

In total, 195 patients were included in the study, with 95 patients in the AT group and 100 in the CG. Postoperative bleeding was significant in the AT group vs. the CG (p = 0.000), with a significant correlation with surgical intervention class C (p = 0.013) and the severity class of bleeding 1a (p = 0.044). There was no significant correlation with procedures of type A, B or C for the other postoperative bleeding gradations (1b, 1c, 2 and 3). There was a statistically significant difference in the occurrence of postoperative bleeding events between the DOAC/APT group and the VK group (p = 0.036), but there were no significant differences regarding the other AT agents.

Conclusion

The continuation of anticoagulation therapy for surgical interventions also seems reasonable for high-risk interventions. Although significantly more postoperative bleeding occurs, the severity of bleeding is low. The perioperative management of anticoagulated patients requires well-coordinated interdisciplinary teamwork and detailed instruction of patients.
Clinical trial registration The study is registered (29.03.2021) at the German clinical trial registry (DRKS00024889).
Literature
1.
Koskinas KC, Lillis T, Tsirlis A, Katsiki N, Giannoglou GD, Ziakas AG. Dental management of antiplatelet-receiving patients: is uninterrupted antiplatelet therapy safe? Angiology. 2012;63(4):245–7.CrossRef
2.
Kammerer PW, Frerich B, Liese J, Schiegnitz E, Al-Nawas B. Oral surgery during therapy with anticoagulants—a systematic review. Clin Oral Investig. 2015;19(2):171–80.CrossRef
3.
Rechenmacher SJ, Fang JC. Bridging anticoagulation: primum non nocere. J Am Coll Cardiol. 2015;66(12):1392–403.CrossRef
4.
Buchbender M, Rossler F, Kesting MR, Frohwitter G, Adler W, Rau A. Management of anticoagulated patients in dentoalveolar surgery: a retrospective study comparing bridging with heparin versus unpaused vitamin K antagonist medication. BMC Oral Health. 2021;21(1):96.CrossRef
5.
Al-Mubarak S, Rass MA, Alsuwyed A, Alabdulaaly A, Ciancio S. Thromboembolic risk and bleeding in patients maintaining or stopping oral anticoagulant therapy during dental extraction. J Thromb Haemost. 2006;4(3):689–91.CrossRef
6.
Wahl MJ, Pinto A, Kilham J, Lalla RV. Dental surgery in anticoagulated patients–stop the interruption. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(2):136–57.CrossRef
7.
Laino L, Cicciu M, Fiorillo L, Crimi S, Bianchi A, Amoroso G, et al. Surgical Risk On Patients With Coagulopathies: Guidelines On Hemophiliac Patients For Oro-Maxillofacial Surgery. Int J Environ Res Public Health. 2019;16(8).
8.
Mehra P, Cottrell DA, Bestgen SC, Booth DF. Management of heparin therapy in the high-risk, chronically anticoagulated, oral surgery patient: a review and a proposed nomogram. J Oral Maxillofac Surg. 2000;58(2):198–202.CrossRef
9.
Troiano G, Laino L, Cicciu M, Cervino G, Fiorillo L, D’Amico C, et al. Comparison of two routes of administration of dexamethasone to reduce the postoperative Sequelae after third molar surgery: a systematic review and meta-analysis. Open Dent J. 2018;12:181–8.CrossRef
10.
Lu SY, Lin LH, Hsue SS. Management of dental extractions in patients on warfarin and antiplatelet therapy. J Formos Med Assoc. 2018;117(11):979–86.CrossRef
11.
Lupi SM, Rodriguez YBA. Patients Taking Direct Oral Anticoagulants (DOAC) undergoing oral surgery: a review of the literature and a proposal of a Peri-operative management protocol. Healthcare (Basel). 2020;8(3).
12.
Kirchhof P, Breithardt G, Bax J, Benninger G, Blomstrom-Lundqvist C, Boriani G, et al. A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference. Europace. 2016;18(1):37–50.CrossRef
13.
Eichhorn W, Burkert J, Vorwig O, Blessmann M, Cachovan G, Zeuch J, et al. Bleeding incidence after oral surgery with continued oral anticoagulation. Clin Oral Investig. 2012;16(5):1371–6.CrossRef
14.
Wahl MJ. Dental surgery and antiplatelet agents: bleed or die. Am J Med. 2014;127(4):260–7.CrossRef
15.
Schmitt CM, Rusche B, Clemm R, Neukam FW, Buchbender M. Management of anticoagulated patients in dentoalveolar surgery: a clinical comparative study. Clin Oral Investig. 2020;24(8):2653–62.CrossRef
16.
Martinez J, Hernandez-Gea V, Rodriguez-de-Santiago E, Tellez L, Procopet B, Giraldez A, et al. Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis. J Hepatol. 2021.
17.
Pereira CM, Gasparetto PF, Carneiro DS, Correa ME, Souza CA. Tooth extraction in patients on oral anticoagulants: prospective study conducted in 108 brazilian patients. ISRN Dent. 2011;2011:203619.
18.
Muller M, Schlittler F, Schaller B, Nagler M, Exadaktylos AK, Sauter TC. Characteristics, treatment and outcome of bleeding after tooth extraction in patients on DOAC and phenprocoumon compared to non-anticoagulated patients-a retrospective study of emergency department consultations. Clin Oral Investig. 2019;23(5):2273–8.CrossRef
19.
Brennan Y, Gu Y, Schifter M, Crowther H, Favaloro EJ, Curnow J. Dental extractions on direct oral anticoagulants vs warfarin: the DENTST study. Res Pract Thromb Haemost. 2020;4(2):278–84.CrossRef
20.
Berton F, Costantinides F, Rizzo R, Franco A, Contarin J, Stacchi C, et al. Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study. Clin Oral Investig. 2019;23(8):3183–92.CrossRef
21.
Varghese KG, Manoharan S, Sadhanandan M. Evaluation of bleeding following dental extraction in patients on long-term antiplatelet therapy: a clinical trial. Indian J Dent Res. 2015;26(3):252–5.CrossRef
22.
Cervino G, Fiorillo L, Monte IP, De Stefano R, Laino L, Crimi S, et al. Advances in antiplatelet therapy for dentofacial surgery patients: focus on past and present strategies. Materials (Basel). 2019;12(9).
23.
Tabrizi R, Khaheshi I, Hoseinzadeh A, Rezvanpour B, Shafie S. Do antiplatelet drugs increase the risk of bleeding after dental implant surgery? A case-and-crossover study. J Oral Maxillofac Surg. 2018;76(10):2092–6.CrossRef
24.
Patel JP, Woolcombe SA, Patel RK, Obisesan O, Roberts LN, Bryant C, et al. Managing direct oral anticoagulants in patients undergoing dentoalveolar surgery. Br Dent J. 2017;222(4):245–9.CrossRef
25.
Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2015;17(10):1467–507.CrossRef
26.
Precht C, Demirel Y, Assaf AT, Pinnschmidt HO, Knipfer C, Hanken H, et al. Perioperative management in patients with undergoing direct oral anticoagulant therapy in oral surgery—a Multicentric Questionnaire Survey. In Vivo. 2019;33(3):855–62.CrossRef
27.
Li L, Zhang W, Yang Y, Zhao L, Zhou X, Zhang J. Dental management of patient with dual antiplatelet therapy: a meta-analysis. Clin Oral Investig. 2019;23(4):1615–23.CrossRef
28.
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 Implants Res. 2016;27(10):1274–82.CrossRef
29.
Febbo A, Cheng A, Stein B, Goss A, Sambrook P. Postoperative bleeding following dental extractions in patients anticoagulated with Warfarin. J Oral Maxillofac Surg. 2016;74(8):1518–23.CrossRef
30.
Caliskan M, Tukel HC, Benlidayi ME, Deniz A. Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants? Med Oral Patol Oral Cir Bucal. 2017;22(6):e767–73.PubMedPubMedCentral
Metadata
Title
A prospective comparative study to assess the risk of postoperative bleeding after dental surgery while on medication with direct oral anticoagulants, antiplatelet agents, or vitamin K antagonists
Authors
Mayte Buchbender
Nicola Schlee
Marco R. Kesting
Jannik Grimm
Jakob Fehlhofer
Andrea Rau
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-021-01868-7

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