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. Th...

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Bibliographic Details
Published in:	Journal of cranio-maxillo-facial surgery Vol. 52; no. 6; pp. 772 - 777
Main Authors:	Bajkin, Branislav V., Tadic, Ana J., Komsic, Jelena J., Vuckovic, Biljana A.
Format:	Journal Article
Language:	English
Published:	Scotland Elsevier Ltd 01-06-2024
Subjects:	Administration, Oral Aged Aged, 80 and over Anticoagulant Anticoagulants - therapeutic use Bleeding risk Female Humans Male Middle Aged Oral surgical procedure Oral Surgical Procedures Postoperative bleeding Postoperative Hemorrhage - chemically induced Prospective Studies Risk Factors Tooth extraction Vitamin K - antagonists & inhibitors Tooth extraction Anticoagulant Postoperative bleeding Bleeding risk Oral surgical procedure
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Summary:	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).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1010-5182 1878-4119 1878-4119
DOI:	10.1016/j.jcms.2024.03.035