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Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study

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Abstract

Objectives

The aim of this prospective comparative clinical study was to evaluate the effect of oral anticoagulants on peri- and post-operative bleeding during simple single tooth extractions, comparing patients in treatment with vitamin K antagonists (VKAs) and patients assuming direct oral anticoagulants (DOACs).

Materials and methods

Patients under oral anticoagulant therapy needing dental extraction were eligible for entering the study; patients were enrolled following inclusion and exclusion criteria and divided into VKAs and DOAC group according to the anticoagulation therapy. Included patients underwent a simple single dental extraction with elevators and forceps with a maximum surgical time of 15 minutes, without anticoagulation therapy discontinuation. All participants were assessed pre-operatively, during surgery, 30 min minutes and 7 days after surgery. Biological complications were registered and post-extraction bleeding was clinically defined according to Iwabuchi classification. Parametric and non-parametric tests were used to evaluate the variables between the groups.

Results

Sixty-five patients per group were enrolled and 130 teeth were extracted. The two groups were comparable for pre-, peri-, and post-operative variables. Only 1 patient of DOAC group and 2 patients for VKA group needed medical evaluation for post-extractive bleeding. No statistically significant difference resulted in post-operative bleeding events between the groups (p = 0.425).

Conclusions

DOAC and VKA patients showed the same incidence of bleeding complications after simple single tooth extraction. Bleeding events were not statistically significant and not clinically relevant.

Clinical relevance

Patients assuming DOACs can be treated similarly to patients in VKAs therapy with INR index between 2 and 3. Non-ceasing of DOAC therapy seems to be appropriate for simple single dental extractions.

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Acknowledgments

The authors wish to thank Alessia Mazzon, Ilaria Benedetti, and Katia Battistuta for the precious work made on the causal periodontal therapy of the enrolled patients. Moreover, a special thanks to the Cardiovascular Center of ASUI Trieste.

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Authors and Affiliations

  1. Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

    Federico Berton, Fulvia Costantinides, Roberto Rizzo, Anna Franco, Jenny Contarin, Claudio Stacchi, Michele Maglione, Erika Visintini & Roberto Di Lenarda

  2. Cardiovascular Center, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

    Andrea Di Lenarda

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  1. Federico Berton
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  2. Fulvia Costantinides
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  3. Roberto Rizzo
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  4. Anna Franco
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  5. Jenny Contarin
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  9. Andrea Di Lenarda
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  10. Roberto Di Lenarda
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Correspondence to Federico Berton.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Berton, F., Costantinides, F., Rizzo, R. et al. Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study. Clin Oral Invest 23, 3183–3192 (2019). https://doi.org/10.1007/s00784-018-2739-9

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  • DOI: https://doi.org/10.1007/s00784-018-2739-9

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