Management of anticoagulated patients in dentoalveolar surgery: a clinical comparative study

  • CM SchmittEmail author
  • B Rusche
  • R Clemm
  • FW Neukam
  • M Buchbender
Original Article



This prospective, comparative, clinical study analyzed the postoperative bleeding risk of patients on anticoagulation therapy (AT) who were undergoing tooth extractions and osteotomies.

Materials and methods

Patients with the following ATs were included (test groups): (1.) platelet aggregation inhibitors (PAIs), (2.) vitamin K inhibitors, (3.) low molecular weight heparin (LMWH), and (4.) direct oral anticoagulants (DOACs). Patients in the control group were not on any AT (non-AT group). Patients were subdivided into the following treatment groups: (1.) single tooth extraction, (2.) serial extraction (≥ 2 adjacent teeth), and (3.) tooth osteotomy. Pre-, intra-, and postoperative data concerning the treatment, extent of the surgery, and bleeding were recorded and statistically evaluated.


There were 15 postoperative bleeding events in 838 patients (1.7%): four (0.7%) in the non-AT group (n = 603 patients) and 11 (4.7%) in the AT group (n = 235 patients). The surgical procedure had no statistically significant effect on postoperative bleeding frequencies. Patients taking vitamin K inhibitors had a significantly higher risk of postoperative bleeding compared with patients without AT (p < 0.00001). Four patients were hospitalized due to the severity of the bleeding (vitamin K inhibitor group). Postoperative bleeding events were all controlled with local hemostatic measures.


The postoperative bleeding risk after tooth extractions and osteotomies in patients continuing AT is low, and bleeding can be controlled with local hemostatic measures.

Clinical relevance

AT should be continued in patients undergoing tooth removal procedures under the provision that local hemostatic measures are applied.


Oral surgery Tooth extraction Osteotomy Anticoagulation therapy 



The present work was part of the studies of the second author Rusche B to obtain the doctoral degree (Dr. med. dent.) at the University of Erlangen-Nuremberg, Erlangen, Germany.

Author contributions

CMS: Contributed to the concept, design, data analyses, and interpretation; drafted the manuscript.

RB: Contributed to the data collection, analyses, and interpretation; critically revised the manuscript and gave final approval.

RC: Contributed to the data collection, critically revised the manuscript, and gave final approval.

NFW: Contributed to the design of the study, critically revised the manuscript, and gave final approval.

BM: Was involved in data collection and drafting of the manuscript, critically revised the manuscript, and gave final approval.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

Ethical approval (No. 92_13B) was obtained from the medical faculties’ ethics committee of the Friedrich-Alexander-University Erlangen-Nuremberg, Germany.

Informed consent

Informed consent for participation in the study and surgical consent prior to the intervention was obtained from every patient at the time of enrollment.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial SurgeryUniversity of Erlangen-NurembergErlangenGermany
  2. 2.MunichGermany
  3. 3.HersbruckGermany
  4. 4.MunichGermany

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