Risk of dentoalveolar surgery postoperative bleeding in patients taking direct oral anticoagulants and vitamin K antagonists: A prospective observational study.

The aim of this study was to evaluate whether direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA) increase the risk of postoperative bleeding after dentoalveolar surgery. Patients were classified into two groups: one taking DOAC and the other taking VKA with a therapeutic INR range. The control group comprised non-anticoagulated subjects. Participants were matched regarding dentoalveolar procedure. The primary predictor was anticoagulant status. The primary outcome was postoperative bleeding. The DOAC group comprised 77 patients, while the VKA group and control group each consisted of 103 participants. In each group, 103 dentoalveolar surgical procedures were conducted. Postoperative bleeding was recorded in 3/103 (2.9%), 5/103 (4.8%), and 1/103 (0.97%) occasions in the DOAC, VKA, and control groups, respectively, without significant difference (χ2; p = 0.54). The fully adjusted odds ratio for postoperative bleeding was 0.14 (CI 0.01-1.61; p = 0.05) for patients taking DOAC and 0.19 (CI 0.02-1.65; p = 0.285) for those taking VKA compared with non-anticoagulated controls. In conclusion, there was no increase in risk for clinically significant postoperative bleeding after dentoalveolar surgery in patients taking DOAC or VKA compared with non-anticoagulated subjects. Dentoalveolar surgery in patients taking DOAC and VKA can be performed safely without therapy cessation. The study was registered at Clinicaltrials.gov (NCT04505475).

Risk factors for bleeding after oral surgery in patients who continued using oral anticoagulant therapy.

BACKGROUND: The authors assessed the incidence of postoperative bleeding in patients who were highly anticoagulated and in patients who underwent extensive oral surgical procedures and who continued using oral anticoagulant therapy. METHODS: The authors placed 125 patients receiving anticoagulant therapy into 1 of 3 groups. Group A had 54 patients who were highly anticoagulated (international normalized ratio [INR] ≥ 3.5) in whom up to 3 teeth were extracted. Group B had 60 patients with INR 2.0 to less than 3.5 in whom higher-risk dentoalveolar surgery (extraction of more than 3 teeth or other oral surgery procedure involving raising a mucoperiosteal flap, osteotomy, or biopsy) was performed. Group C had 11 patients whose INR values were 3.5 or higher and who required higher-risk dentoalveolar surgery. Eighty-five healthy participants who underwent surgical procedures similar to those performed in group A and group B were the control group. RESULTS: Two patients in group A (3.7%), 3 in group B (5.0%), and 2 in group C (18.2%) experienced postoperative bleeding. In the control group, a single bleeding event (1.2%) occurred. All cases of hemorrhage were mild and easily controlled using local hemostatic measures. CONCLUSIONS: Dental extractions in patients who are highly anticoagulated (INR, 3.5-4.2), as well as more extensive oral surgical procedures in patients who are therapeutically anticoagulated, can be performed safely without interruption or modification of the therapy. PRACTICAL IMPLICATIONS: Tooth extractions and even more extensive surgical procedures can be performed safely in patients who continue using anticoagulant therapy if proper local hemostatic measures are used and if no other coagulopathies are present.