Key result
DOAC continuation linked to ~94% higher post-extraction bleeding risk vs. healthy controls, mostly minimal.
Why the study?
Patients prescribed anticoagulants undergoing tooth extraction pose a clinical risk of protracted or substantial bleeding, requiring evaluation of postoperative bleeding and pain while continuing DOAC therapy.
Does continuing DOAC therapy increase postoperative bleeding or pain following tooth extraction compared to healthy controls?
Case-Control (n=430)
Single-blind
No
Does continuing DOAC therapy increase postoperative bleeding or pain following tooth extraction compared to healthy controls?
Absolute Event Rate: 52.1% vs 26.9%
p-value: p=<0.001
Continuing DOAC therapy during tooth extraction appears clinically safe with manageable bleeding, supporting an individualized approach rather than routine discontinuation.
Higher bleeding grades with DOACs post-extraction remained manageable with comparable pain; leaves open whether continuation is routinely safe.
BACKGROUND: Patients prescribed anticoagulants, even a seemingly uncomplicated extraction can pose a significant clinical risk of protracted or substantial bleeding. The aim of this study was to evaluate postoperative bleeding, pain scores, and oral healing parameters in patients undergoing tooth extractions while continuing direct oral anticoagulant (DOAC) therapy, compared to healthy controls. METHODS: A prospective, single-blind case-control study was conducted involving 211 patients receiving DOAC therapy (apixaban, dabigatran, edoxaban, rivaroxaban) and 219 healthy control participants without anticoagulant therapy. Postoperative bleeding was assessed using a five-level bleeding grade on day 7, alongside pain evaluation via the Visual Analog Scale (VAS) and clinical assessment of erythema, edema, suppuration, and bone exposure. The data were analysed using Chi-square, Kruskal-Wallis H and Mann-Whitney U tests. Significance level was considered as 0.05. RESULTS: Minimal postoperative bleeding was observed in most patients, regardless of anticoagulation status. However, higher bleeding grades were more common in the DOAC group, particularly among rivaroxaban (grade 2–2 in 6.9% and grade 3 in 13.8%) and edoxaban (3.6% and 7.3%, respectively) takers. Pain scores were similar across groups (mean VAS: case group 4.01 ± 2.01, control group 3.95 ± 2.04; p = 0.848). Erythema/edema rates did not significantly differ between groups (p = 0.930), whereas bone exposure was more frequent in the DOAC group (p = 0.039). No significant differences in suppuration rates were found (p = 0.548). CONCLUSIONS: Continuing DOAC therapy during tooth extractions appears clinically safe when meticulous surgical techniques and local hemostatic measures are employed. Although bleeding severity may vary among different DOACs, overall outcomes remain manageable. These findings support an individualized, risk-based perioperative approach rather than routine anticoagulant discontinuation.
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İlhan Kaya (2025) conducted a case-control in Single tooth extraction (n=430). Direct oral anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban) vs. No anticoagulant therapy was evaluated on Postoperative bleeding (Grades 1-3) (p=<0.001). Direct oral anticoagulant therapy during single tooth extraction was associated with a higher incidence of postoperative bleeding compared to healthy controls (52.1% vs 26.9%, p < 0.001), though most cases were minimal and clinically manageable.
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