Key result
A 24-hour rivaroxaban hold shows zero major bleeds during dental implant surgery.
Why the study?
Management of patients on Direct Oral Anticoagulants like Rivaroxaban poses clinical challenges balancing hemorrhagic risk and thromboembolism risk during implant placement.
Does a 24-hour interruption of Rivaroxaban prevent major bleeding complications during dental implant placement with immediate loading?
Observational (n=12)
Yes
Does a 24-hour interruption of Rivaroxaban prevent major bleeding complications during dental implant placement with immediate loading?
A 24-hour discontinuation of rivaroxaban appears safe for multiple dental implant placements with immediate loading, without major bleeding complications.
Answers are grounded in this paper and cite their sources.
Case report suggests possible safety of brief rivaroxaban interruption for implants; should not change practice pending controlled trials.
The management of patients under treatment with Direct Oral Anticoagulants (DOACs) has led clinicians to deal with two clinical issues, such as the hemorrhagic risk in case of non-interruption or the risk of thromboembolism in case of suspension of the treatment. The primary aim of this retrospective study was to evaluate the incidence of perioperative bleeding events and healing complications in patients who were under treatment with Rivaroxaban and who received dental implants and immediate prosthetic restoration. Patients treated with Rivaroxaban (Xarelto 20 mg daily) and who needed implant rehabilitation were selected. Four to six implants were placed in mandibular healed sites or fresh extraction sockets. All patients, in agreement with their physicians, interrupted the medication for 24 h and received implants and immediate restorations. Twelve patients and 57 implants were analyzed in the study. No major postoperative bleeding events were reported. Three patients (25%) presented slight immediate postoperative bleeding controlled with compression only. The implant and prosthetic survival rate were both 100% after 1 year. Within the limitations of this study, multiple implant placement with an immediate loading can be performed without any significant complication with a 24 h discontinuation of Rivaroxaban, in conjunction with the patient's physician.
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Guido et al. (2020) conducted an observational in Patients under treatment with Rivaroxaban needing full-arch implant-supported mandibular rehabilitation (n=12). 24-hour discontinuation of Rivaroxaban was evaluated on Incidence of perioperative bleeding events. A 24-hour discontinuation of Rivaroxaban prior to multiple implant placement with immediate loading resulted in no major bleeding events, with only 25% of patients experiencing slight bleeding controlled by compression.
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