Key result
Continuation of oral anticoagulants peri-operatively during dental implant surgery increased the risk of bleeding complications compared to no anticoagulation (RR 2.30).
Why the study?
Optimal management of anticoagulated patients undergoing dental implant placement remains controversial, balancing the risk of bleeding against the risk of thrombosis.
Does the continuation of oral anticoagulants increase the risk of bleeding events in patients undergoing dental implant placement?
Meta-Analysis (n=1,467)
Does the continuation of oral anticoagulants increase the risk of bleeding events in patients undergoing dental implant placement?
Continuing oral anticoagulants during dental implant surgery increases the risk of minor bleeding, but these events are not clinically significant and can be managed with simple local hemostatic measures.
Answers are grounded in this paper and cite their sources.
Supports continuing oral anticoagulants with local hemostasis for dental implants; confirms elevated but clinically minor bleeding risk.
BACKGROUND: Dental implant placement is safe and predictable, yet optimal management of anticoagulated patients remains controversial. Whilst cessation of anticoagulation pre-operatively should decrease risks of bleeding, risk of thrombosis increases. We aim to define risk of bleeding in patients on oral anticoagulation who are undergoing dental implant placement, in order to establish best management. METHODS: This systematic review is registered with the National Institute for Health Research (NIHR) PROSPERO database (Registration No: CRD42021233929). We performed a systematic review as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Studies were identified using an agreed search strategy within the OVID Gateway (this included Pubmed, MEDLINE, Cochrane Collaborative). Studies assessing bleeding complications in patients who were undergoing dental implant placement were selected. The primary outcome was bleeding events in anticoagulated patients undergoing dental implant placement. Secondary outcomes included any complication requiring further intervention. RESULTS: We identified 182 studies through screening, and after review of titles and abstracts reduced this to 8 studies. In these studies, 1467 participants received at least 2366 implants. Studies were analysed for quality using the ROBINS-I risk of bias tool. Four studies were retrospective case reviews, and four were prospective reviews, three of which also blinded the operator to anticoagulation status. There was significant heterogeneity between the included studies. Meta-analysis showed an increased risk of bleeding (RR, 2.30; 95% CI, 1.25-4.24 p = 0.37 I = 7%) when implants were placed in the presence of anticoagulation however these were not clinically significant haemorrhagic events. CONCLUSION: The continuation of anticoagulants peri-operatively during dental implant surgery does increase the risk of clinically non-significant peri- and post-operative bleeding. Dental implant surgery encompasses a broad spectrum of procedures ranging from minor to more invasive surgery with simple local haemostatic measures mitigating the risk of bleeding. The decision to discontinue anticoagulants prior to dental implant surgery must consider patient and surgical factors with the clinician undertaking a risk-balance assessment.
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Dawoud et al. (2021) conducted a meta-analysis in Patients on oral anticoagulants undergoing dental implant placement (n=1,467). Continuation of oral anticoagulants vs. No anticoagulation was evaluated on Bleeding events requiring treatment or complications within 7 days (RR 2.30, 95% CI 1.25-4.24, p=0.37). Continuation of oral anticoagulants peri-operatively during dental implant surgery increased the risk of bleeding complications compared to no anticoagulation (RR 2.30).
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