Key result
DOACs linked to significantly less post-extraction bleeding than warfarin.
Why the study?
Does continuing direct oral anticoagulants without alteration reduce bleeding compared to warfarin in patients undergoing single tooth extraction?
Observational (n=84)
Single-blind
No
Does continuing direct oral anticoagulants without alteration reduce bleeding compared to warfarin in patients undergoing single tooth extraction?
p-value: p=<0.05
Continuing direct oral anticoagulants without alteration during simple tooth extraction is safe and results in significantly less bleeding compared to continuing warfarin.
Comparable bleeding without interrupting therapy supports continuation in practice; leaves open need for randomized confirmation.
BACKGROUND: The number of patients using direct oral anticoagulants (DOACs) instead of vitamin K antagonists (VKA) is increasing and there is limited data on the safety of tooth extractions in patients taking DOACs. The aim of this study was to compare the amount of bleeding (AOB) and postoperative complications after tooth extractions between patients taking VKAs and patients taking DOACs without altering the anticoaguation therapy. MATERIAL AND METHODS: The study consisted of four groups: Direct thrombin inhibitor group, factor Xa inhibitor group, warfarin group and a control group. A single tooth was extracted in each patient and routine coagulation test values were recorded prior to extraction. AOB was measured for 20 minutes after tooth extraction. The patients were evaluated on 2nd and 7th days after extraction for bleeding. Status of bleeding was classified as no bleeding, mild bleeding controlled by gauze pads, moderate bleeding controlled by hemostatic agents and severe bleeding required hospitalization. Analysis of variance, chi square test and correlation analysis were used for statistical analysis of data. RESULTS: A total of 84 patients (48 male, 36 female) were included in this study. The mean age of patients was 57 (38-87) years. Mean AOB was 1388.6±913.0, 1909.29±1063.1, 3673±1415.4, 1593.33±672.5 mg for direct thrombin inhibitor, factor Xa inhibitor, warfarin and control groups respectively. Mean AOB was significantly higher for warfarin group, compared to other groups (p<0.05). The number of patients showing mild and moderate bleeding was significantly higher in warfarin group compared to other groups on the 2nd postextraction day (p=0.001). No bleeding was occurred in control group on 2nd and 7th postextraction days and no bleeding was occurred in direct thrombin inhibitor group on 7th postextraction day. The number of bleeding events among groups was not statistically significant on 7th postextraction day (p=0.251). CONCLUSIONS: Patients taking warfarin had more bleeding compared to patients taking direct oral anticoagulants after tooth extractions. In patients taking direct oral anticoagulants simple tooth extractions can be safely carried out without altering the anticaogulant regimen with the use of local hemostatic agents.
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TÜKEL et al. (2017) conducted an observational in Patients requiring tooth extraction taking oral anticoagulants (n=84). Direct oral anticoagulants (DOACs) vs. Warfarin and no anticoagulants was evaluated on Amount of bleeding (AOB) measured for 20 minutes after tooth extraction (p=<0.05). Patients taking warfarin had a significantly higher mean amount of bleeding (3673 mg) compared to those taking direct thrombin inhibitors (1388.6 mg) or factor Xa inhibitors (1909.2 mg).