Key result
Among 19 patients undergoing tooth extraction while maintaining NOAC therapy, persistent postoperative bleeding occurred in 1 patient on rivaroxaban, and mild oozing occurred in 5 patients.
Why the study?
Is tooth extraction safe without interrupting nonvitamin K antagonist oral anticoagulant therapy?
Observational (n=19)
Is tooth extraction safe without interrupting nonvitamin K antagonist oral anticoagulant therapy?
Tooth extraction can generally be performed safely while maintaining NOAC therapy, though surgical extraction in patients on rivaroxaban with prolonged prothrombin time may carry a higher bleeding risk.
May support uninterrupted NOAC use for tooth extraction; leaves open need for larger prospective trials.
BACKGROUND/PURPOSE: The nonvitamin K antagonist oral anticoagulants direct-thrombin inhibitor dabigatran and the Xa inhibitors rivaroxaban and apixaban are now being used clinically. The course of the patients on these anticoagulants who underwent tooth extraction was assessed. MATERIALS AND METHODS: The medical charts of these patients were investigated. Tooth extraction was performed while maintaining conventional anticoagulant therapy. RESULTS: Twenty-three teeth were extracted in 19 patients, including two surgical extractions. Among the 19 patients, nine patients ingested rivaroxaban, six apixaban, and four dabigatran. One patient on rivaroxaban showed persistent postoperative bleeding following two surgical extractions. Mild oozing was observed in five patients (two on rivaroxaban and three on apixaban). There was no bleeding episode in the patients on dabigatran. CONCLUSION: The patients on rivaroxaban with a prolonged prothrombin time value have a higher risk of bleeding, especially undergoing surgical extraction. Apixaban correlates to neither activated partial thromboplastin time nor prothrombin time values and the countermeasures should be employed based on the clinical findings.
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Morimoto et al. (2015) conducted an observational in Patients taking nonvitamin K antagonist oral anticoagulants requiring tooth extraction (n=19). Nonvitamin K antagonist oral anticoagulants (rivaroxaban, apixaban, dabigatran) was evaluated on Postoperative bleeding. Among 19 patients undergoing tooth extraction while maintaining NOAC therapy, persistent postoperative bleeding occurred in 1 patient on rivaroxaban, and mild oozing occurred in 5 patients.
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