Direct Oral Anticoagulants (DOAC) in oral implant surgery – a metaanalysis

Abstract

Background As oral surgical procedures like implantations and augmentative procedures per se can lead to severe haemorrhagia, in particular patients on anticoagulants require appropriate management. The “Graz Considerations for Compromised Coagulation” (GCCC) have been introduced to international field specialists in Vienna, Austria, in 2005 and takes most of invasive dental treatments into account. The recent update of the GCCC has forwarded the optimal peri-procedural haemostatic strategy by. Material and Methods To identify relevant studies a comprehensive and systematic literature research in high-yield journals and the electronic database PubMed was conducted. The broad spectrum of information about perioperative hemostatic strategies was examined using the following search terms – “oral surgery“, “implant surgery“, “DOAC” and the agents’ proper names. In light of relevant international publications we evaluate our current findings in an ongoing study at our department. Results Characteristics of included studies are compared with the pertinent data of our study and listed in tabular form. Seven published papers were included in our critical evaluation. Two cohort studies tested continuation versus discontinuation of DOAC (Rivaroxaban, Xarelto®) for certain procedures in oral surgery. In one study group no significance for bleeding events of dental implantations was detected in comparison to normal population while another trial showed significance. Three work groups presented their protocols of temporary discontinuation of Dabigatran (Pradaxa®). In strict accordance with their periprocedural strategies the authors observed no significant difference of bleeding events. One working group provides detailed recommendations in a review, but had not assessed them in a clinical trial. An Australian study team recommends both continuation and discontinuation of Dabigatran according to the individual bleeding risk, nevertheless their results may not be represent. Conclusions and Clinical Implications Hematologists advise a minimum time-interval of last dose to intervention. In accordance with our clinical study results we found that continuation of DOAC therapy is advisable for simple implantation without increased risk of local haemorrhage. The DOACs’ temporary suspension may, however, show fewer bleeding events in procedures such as complex implantation. As limited data regarding bleeding in implant patients under DOAC therapy is available further studies are needed to determine.