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Risk factors associated with post-extraction bleeding in patients on warfarin or direct-acting oral anticoagulants: a retrospective cohort study

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Abstract

Purpose

The purpose of this study was to investigate the risk factors associated with post-extraction persistent bleeding in patients on warfarin or direct-acting oral anticoagulants (DOACs) and the ability of risk scores to predict post-extraction bleeding.

Methods

Three hundred ninety-one patients taking warfarin or DOACs underwent tooth extractions. Various risk factors for post-extraction bleeding, including number of tooth extraction, with antiplatelet therapy, and risk scores, were investigated by univariate and multivariate analyses. A post-extraction bleeding was classified into grades 1–3.

Results

The incidence of post-extraction bleeding was 26.8% (77 out of 287 patients; grade 1: 63, grade 2:14) in patients taking warfarin, and 26.0% (27 out of 104 patients; grade 1: 20, grade 2:7) in patients taking warfarin DOACs. Multivariate analyses showed that multiple teeth extractions and HAS-BLED scores (above 3 points) in patients taking warfarin, and only multiple teeth extractions in patients taking DOAC, were significantly associated with post-extraction bleeding, respectively.

Conclusion

Most of the post-extraction bleedings were grade 1, which can be stopped by eligibly pressing gauze by surgeons. If patients taking anticoagulants are scheduled to undergo multiple teeth extractions or their HAS-BLED score are above 3 points (if warfarin), we recommend informing patients risk of post-extraction bleeding before operation, taking carefully hemostasis, and instructing patients to bite down accurately on the gauze for longer than usual.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan

    Eiji Iwata, Akira Tachibana, Ryo Kadoya, Yui Enomoto & Naoki Takata

  2. Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Eiji Iwata, Junya Kusumoto, Takumi Hasegawa & Masaya Akashi

Authors
  1. Eiji Iwata
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  2. Akira Tachibana
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  3. Junya Kusumoto
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  4. Takumi Hasegawa
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  5. Ryo Kadoya
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  6. Yui Enomoto
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  7. Naoki Takata
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  8. Masaya Akashi
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Contributions

Study design: E Iwata

Acquisition of data: E Iwata, R Kadoya, Y Enomoto

Analysis and interpretation of data: E Iwata, A Tachibana, M Akashi

Manuscript preparation: E Iwata, A Tachibana, J Kusumoto, T Hasegawa, R Kadoya, Y Enomoto, N Takata, M Akashi

Manuscript editing: E Iwata, M Akashi

Manuscript review: E Iwata, A Tachibana, J Kusumoto, T Hasegawa, R Kadoya, Y Enomoto, N Takata, M Akashi

Statistical analysis: E Iwata, A Tachibana, J Kusumoto, M Akashi

Corresponding author

Correspondence to Eiji Iwata.

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Ethical approval

This retrospective study has been conducted in full accordance with the World Medical Association Declaration of Helsinki and was approved by the Ethical Committee of Kakogawa Central City Hospital approved the study design (authorization number: 2019–84).

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Not applicable.

Conflict of interest

The authors declare no competing interest.

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Iwata, E., Tachibana, A., Kusumoto, J. et al. Risk factors associated with post-extraction bleeding in patients on warfarin or direct-acting oral anticoagulants: a retrospective cohort study. Oral Maxillofac Surg 26, 641–648 (2022). https://doi.org/10.1007/s10006-022-01039-0

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  • DOI: https://doi.org/10.1007/s10006-022-01039-0

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