Abstract
BackgroundThe number of patients using direct oral anticoagulants (DOACs) instead of vitamin K antagonists (VKA) is increasing and there is limited data on the safety of tooth extractions in patients taking DOACs. The aim of this study was to compare the amount of bleeding (AOB) and postoperative complications after tooth extractions between patients taking VKAs and patients taking DOACs without altering the anticoaguation therapy.Material and MethodsThe study consisted of four groups: Direct thrombin inhibitor group, factor Xa inhibitor group, warfarin group and a control group. A single tooth was extracted in each patient and routine coagulation test values were recorded prior to extraction. AOB was measured for 20 minutes after tooth extraction. The patients were evaluated on 2nd and 7th days after extraction for bleeding. Status of bleeding was classified as no bleeding, mild bleeding controlled by gauze pads, moderate bleeding controlled by hemostatic agents and severe bleeding required hospitalization. Analysis of variance, chi square test and correlation analysis were used for statistical analysis of data.ResultsA total of 84 patients (48 male, 36 female) were included in this study. The mean age of patients was 57 (38-87) years. Mean AOB was 1388.6±913.0, 1909.29±1063.1, 3673±1415.4, 1593.33±672.5 mg for direct thrombin inhibitor, factor Xa inhibitor, warfarin and control groups respectively. Mean AOB was significantly higher for warfarin group, compared to other groups (p<0.05). The number of patients showing mild and moderate bleeding was significantly higher in warfarin group compared to other groups on the 2nd postextraction day (p=0.001). No bleeding was occurred in control group on 2nd and 7th postextraction days and no bleeding was occurred in direct thrombin inhibitor group on 7th postextraction day. The number of bleeding events among groups was not statistically significant on 7th postextraction day (p=0.251).ConclusionsPatients taking warfarin had more bleeding compared to patients taking direct oral anticoagulants after tooth extractions. In patients taking direct oral anticoagulants simple tooth extractions can be safely carried out without altering the anticaogulant regimen with the use of local hemostatic agents. Key words:Direct oral anticoagulants, dabigatran, rivaroxaban, apixaban, tooth extraction, oral surgery.
Highlights
Treatment or prophylaxis of thromboembolism in several diseases and medical conditions including prosthetic cardiac valves, chronic atrial fibrillation, stroke, recurrent myocardial infarction, deep vein thrombosis and pulmonary embolism may require extended anticoagulation therapy
The mean amount of bleeding (AOB) in warfarin group was significantly higher than the other groups (p
There is a considerable amount of literature that supports the continuation of vitamin K antagonists (VKA) in minor surgical procedures such as tooth extraction
Summary
Treatment or prophylaxis of thromboembolism in several diseases and medical conditions including prosthetic cardiac valves, chronic atrial fibrillation, stroke, recurrent myocardial infarction, deep vein thrombosis and pulmonary embolism may require extended anticoagulation therapy. Warfarin is the most commonly prescribed VKA it has many disadvantages like food and drug interactions, the need for individual dosing, regular monitoring and dose adjustment, slow onset and offset of action and a hypercoagulable state as a result of warfarin-mediated protein C and S deficiency that develops in some patients [2,3] To overcome these disadvantages and difficulties new oral anticoagulants or DOACs have been developed in the recent years [4]. There are only limited amount of clinical studies in patients taking DOACs who require dental extractions/oral surgery [15,16,17,18] The aim of this prospective, observational study was to compare the AOB and postoperative complications after tooth extractions in patients taking warfarin, direct thrombin inhibitors and factor Xa inhibitors. In patients taking direct oral anticoagulants simple tooth extractions can be safely carried out without altering the anticaogulant regimen with the use of local hemostatic agents
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