Risk of bleeding during flapless immediate implant placement after tooth extraction in patients taking antithrombotics

Objectives To assess postoperative bleeding in patients undergoing immediate implant placement after tooth extraction without discontinuing or adjusting the dosage of oral antithrombotic drugs. Materials and methods Patients from February 2020 to August 2022 were selected who had undergone flapless immediate implant placements after tooth extraction and were on antithrombotics. A total of 27 patients were included. The patients were on different types of anticoagulants: vitamin K antagonists (one patient), non‐vitamin K oral anticoagulants (NOACs) (five), antiplatelet agents (15), dual antiplatelet therapy (five), and combination of anticoagulant and antiplatelet agents (one). Results One patient taking an anticoagulant (NOACs: apixaban) and antiplatelet agent (clopidogrel) showed mild bleeding at the implant placement site in the lower right canine area, and gauze compression was applied to control the bleeding. No special treatment was required for the other patients. There were no implant failures after surgery. Conclusions This study shows that the flapless immediate implant placements after tooth extraction for patients taking antithrombotics can be safely executed under adequate hemostasis without medication cessation. However, when anticoagulants and antiplatelets are taken together, it is speculated that surgeons may need careful hemorrhage management. Future research should include larger patient cohorts to yield more comprehensive evidence.