Postoperative Bleeding in Patients Under Direct Oral Anticoagulation After Maxillary Sinus Floor Augmentation: A Case-Control Study.

Abstract

The aim of this case-control study was to investigate the occurrence of bleeding events related to maxillary sinus elevation with a lateral window in patients under direct oral anticogulant therapy. Seventyseven consecutive patients were scheduled for unilateral maxillary sinus floor elevation using a lateral window approach. Participants were divided into two groups: group A, formed by 37 patients who were under novel oral anticoagulation therapy (rivaroxaban/apixaban), and a control group, composed of 40 healthy subjects. Within group A, assumption of direct oral anticoagulants was not suspended nor modified before surgical procedures. Time (early/delayed) and site (intraoral/extraoral) of bleeding episodes were recorded in both groups of patients, in addition to bleeding severity (mild, moderate, or severe). Maxillary sinus floor elevation was performed in all patients. One dropout happened due to intraoperative membrane perforation. Overall bleeding episodes were comparable in both groups, chi-square (1) = .68, P = .41. Early intraoral bleeding events were more common in absolute terms, but also occurred with approximately the same frequency in both group A and the control group (Fisher exact tests: P = 1.00 and P = .375, respectively). No severe bleeding was observed in any of the attended patients. Within the limitations of this case-control study, maxillary sinus floor augmentation with a lateral window approach can be safely administered to patients who are under direct oral anticoagulation therapy when specific recommendations are instituted.