Abstract
ObjectivesBleeding after tooth extraction range from minor bleeding to life-threating haemorrhagic shock and are among the leading complications in patients under oral anticoagulation with direct oral anticoagulants (DOACs) or phenprocoumon. Little is known about how anticoagulation in patients under DOAC or phenprocoumon alters the characteristics, treatment or outcome of bleeding events, in comparison to non-anticoagulated patients.MethodsPatients admitted to a tertiary ED in Bern, Switzerland, from June 1st 2012 to 31st May 2016 with bleeding related to tooth extraction under DOAC, phenprocoumon or without anticoagulation, were compared.ResultsOut of 161,458 emergency consultations, 64 patients with bleeding from tooth extraction were included in our study. In anticoagulation groups, we found significantly more delayed bleeding events than in patients without anticoagulation (9 (81.3%) DOAC, 19 (86.4%) phenprocoumon, 8 (30.8%) no anticoagulation, p < 0.001). Anticoagulated patients had to stay longer in the ED than non-anticoagulated patients, with no significant difference between DOAC or phenprocoumon (hours: 4.8 (3.2–7.6 IQR) DOAC, 3.0 (2.0–5.5 IQR) phenprocoumon, p = 0.133; 2.7 (1.6–4.6) no anticoagulation; p = 0.039). More patients with anticoagulation therapy needed surgery than patients without anticoagulant therapy (11 (68.8%) DOAC, 12 (54.6%) VKA, p = 0.506; 7(26.9%) no anticoagulation; p = 0.020).ConclusionsDelayed bleeding occur more often in anticoagulated patients with both DOAC and phenprocoumon compared to patients without anticoagulation. Bleeding events in anticoagulated patients with DOAC and phenprocoumon equally need longer ED treatment and more frequent surgical intervention.Clinical relevanceCaution with delayed bleeding in anticoagulated patients with DOACs and phenprocoumon is necessary and treatment of bleeding is resource-demanding.
Highlights
Bleeding events are one of the leading complications after tooth extraction, with an incidence of up to 25%
In analogy to vitamin K antagonists, guidelines on the management of anticoagulants and tooth extraction recommend that direct oral anticoagulant (DOAC) therapy should be continued in most dental procedures [4]
All three patient groups were comparable with respect to gender (male: 7 (43.8%) DOAC vs. 13 (59.1%) vitamin K antagonist (VKA) vs. 15 (57.7%) no anticoagulation; p = 0.657) as well as in the number of teeth extracted (single tooth: 15 (93.8%) DOAC vs. (86.4%) VKA vs. (76.9%) no anticoagulation; p = 0.343) and region of extraction
Summary
Bleeding events are one of the leading complications after tooth extraction, with an incidence of up to 25%. Previous studies have found no significant difference in bleeding incidence between patients on oral anticoagulant therapy with the vitamin K antagonist (VKA) warfarin than with patients without anticoagulant medication [2, 3]. In analogy to vitamin K antagonists, guidelines on the management of anticoagulants and tooth extraction recommend that direct oral anticoagulant (DOAC) therapy should be continued in most dental procedures [4]. Major bleeding complications can lead to admission to the emergency department (ED). This is becoming increasingly common with the growth in the use of DOACs [5]. A lack of evidence-based work on the management of bleeding events was identified [3]
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