Key result
Uninterrupted anticoagulation is linked to ~24% higher post-dental bleeding, though severity remains predominantly low.
Why the study?
The occurrence and severity of postoperative bleeding following dentoalveolar surgery in patients with uninterrupted anticoagulation therapy were not well characterized.
Does uninterrupted anticoagulation therapy increase the risk and severity of postoperative bleeding in patients undergoing dental surgery compared to non-anticoagulated patients?
Cohort (n=195)
Open-label
No
Does uninterrupted anticoagulation therapy increase the risk and severity of postoperative bleeding in patients undergoing dental surgery compared to non-anticoagulated patients?
Absolute Event Rate: 26.3% vs 2%
p-value: p=<0.001
Continuation of anticoagulation therapy during dental surgery increases the frequency of mild postoperative bleeding but does not significantly increase severe bleeding, supporting its continuation even for high-risk dental interventions.
Associated with higher mild bleeding rates after dental procedures; leaves open whether uninterrupted anticoagulation remains safe without randomized confirmation.
BACKGROUND: The aim of this prospective study was to investigate the occurrence and severity of postoperative bleeding following dentoalveolar surgery in patients with uninterrupted anticoagulation therapy (AT). METHODS: Patients receiving AT (vitamin k antagonist (VK), direct oral anticoagulants (DOAC) or antiplatelet therapy (APT) and in need of surgical intervention classified as A, B or C (single or serial tooth extraction, osteotomy, or implant placement) were studied between 2019 and 2021. A healthy, non-anticoagulated cohort (CG) served as a control group. The main outcomes measured were the frequency of postoperative bleeding, the classification of the severity of postoperative bleeding (1a, 1b, 1c, 2, 3), and the correlation with the AT surgical intervention classification. RESULTS: In total, 195 patients were included in the study, with 95 patients in the AT group and 100 in the CG. Postoperative bleeding was significant in the AT group vs. the CG (p = 0.000), with a significant correlation with surgical intervention class C (p = 0.013) and the severity class of bleeding 1a (p = 0.044). There was no significant correlation with procedures of type A, B or C for the other postoperative bleeding gradations (1b, 1c, 2 and 3). There was a statistically significant difference in the occurrence of postoperative bleeding events between the DOAC/APT group and the VK group (p = 0.036), but there were no significant differences regarding the other AT agents. CONCLUSION: The continuation of anticoagulation therapy for surgical interventions also seems reasonable for high-risk interventions. Although significantly more postoperative bleeding occurs, the severity of bleeding is low. The perioperative management of anticoagulated patients requires well-coordinated interdisciplinary teamwork and detailed instruction of patients. Clinical trial registration The study is registered (29.03.2021) at the German clinical trial registry (DRKS00024889).
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Buchbender et al. (2021) conducted a cohort in Patients requiring dentoalveolar surgery (n=195). Uninterrupted anticoagulation therapy (DOAC, APT, or VK antagonists) vs. Healthy, non-anticoagulated control group was evaluated on Frequency of postoperative bleeding (p=<0.001). Uninterrupted anticoagulation therapy during dental surgery significantly increased the frequency of postoperative bleeding compared to healthy controls (26.3% vs 2.0%, p<0.001), although the severity of bleeding was predominantly low.
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