Characteristics, Treatment and Outcome of Bleeding After Tooth Extraction in Patients on DOAC and Phenprocoumon Compared to Non-anticoagulated Patients-a Retrospective Study of Emergency Department Consultations

Overview

Journal Clin Oral Investig

Specialty Dentistry

Date 2018 Oct 7

PMID 30291493

Citations 7

Authors

Martin Muller

Fabian Schlittler

Benoit Schaller

Michael Nagler

Aristomenis K Exadaktylos

Thomas C Sauter

Affiliations

Soon will be listed here.

Abstract

Objectives: Bleeding 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.

Methods: Patients 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.

Results: Out 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).

Conclusions: Delayed 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 Relevance: Caution with delayed bleeding in anticoagulated patients with DOACs and phenprocoumon is necessary and treatment of bleeding is resource-demanding.

Citing Articles

Influence of antiplatelet medication and anticoagulation therapy after dental extractions on hospitalization: a retrospective 10-year study.

Katz M, Benidamou R, Ooms M, Heitzer M, Bock A, Elvers D BMC Oral Health. 2024; 24(1):1485.

PMID: 39673056 PMC: 11645788. DOI: 10.1186/s12903-024-05275-6.

Post-extraction bleeding in patients on direct oral anticoagulants.

Kim M, Kim M, Kang S J Korean Assoc Oral Maxillofac Surg. 2024; 50(4):189-196.

PMID: 39211967 PMC: 11372225. DOI: 10.5125/jkaoms.2024.50.4.189.

Systematic review on the effects of the discontinuation of the anticoagulant therapy and the postoperative bleeding, in patients under new oral anticoagulants after dental extraction.

Lopez-Galindo M, Grau-Benitez M J Clin Exp Dent. 2023; 15(4):e338-e345.

PMID: 37152496 PMC: 10155941. DOI: 10.4317/jced.60122.

A prospective comparative study to assess the risk of postoperative bleeding after dental surgery while on medication with direct oral anticoagulants, antiplatelet agents, or vitamin K antagonists.

Buchbender M, Schlee N, Kesting M, Grimm J, Fehlhofer J, Rau A BMC Oral Health. 2021; 21(1):504.

PMID: 34620135 PMC: 8499467. DOI: 10.1186/s12903-021-01868-7.

Update on the management of anticoagulated and antiaggregated patients in dental practice: Literature review.

Costa-Tort J, Schiavo-Di Flaviano V, Gonzalez-Navarro B, Jane-Salas E, Estrugo-Devesa A, Lopez-Lopez J J Clin Exp Dent. 2021; 13(9):e948-e956.

PMID: 34603625 PMC: 8464381. DOI: 10.4317/jced.58586.

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