Abstract
BackgroundThe 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).MethodsPatients 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.ResultsIn 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.ConclusionThe 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).
Highlights
Due to the increased prevalence of cardiovascular diseases, the number of long-term anticoagulated patients continues to increase worldwide [1]
In the antiplatelet therapy (APT) group, 43 patients were treated with ASS®, 7 with clopidogrel and 1 with ticagrelor
Discontinuation of anticoagulation therapy (AT) can lead to thromboembolic events with potentially lethal outcomes [6, 14], so the main question always remains the same when it comes to dental surgery: when does the patients need to pause or what are the consequences if it is not paused? To answer this question, the type of surgery and the associated risk of bleeding must be assessed in advance, and the surgical approach must be planned in detail
Summary
Background Due to the increased prevalence of cardiovascular diseases, the number of long-term anticoagulated patients continues to increase worldwide [1]. With increasing incidences of these diseases, anticoagulation therapy remains a main issue in oral surgery and dental surgical procedures [4]. Even if the continuation of anticoagulation does not result in a life-threatening condition of the patient, discomfort from postoperative bleeding may still emerge from the surgical re-entry to stop bleeding, and even hospitalisation can occur [4]. We know that the surgical intervention, respectively the intraoperative procedure possibly shows an effect on the postoperative bleeding events or postoperative sequalae [9]. 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)
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