Key result
Dual antithrombotic therapy is linked to ~132% higher post-extraction bleeding risk versus monotherapy.
Why the study?
The study aimed to identify high-risk dental extraction patients on antiplatelet or anticoagulant therapy and the timing of postoperative hemorrhage to evaluate the need for preventive hospitalization.
Does dual antithrombotic therapy increase the risk of postoperative hemorrhage compared to monotherapy in patients undergoing dental extractions?
Cohort (n=1,280)
No
Does dual antithrombotic therapy increase the risk of postoperative hemorrhage compared to monotherapy in patients undergoing dental extractions?
Odds Ratio: 2.315 (95% CI 1.29–4.149)
Absolute Event Rate: 9.1% vs 3.4%
p-value: p=0.005
Dual antithrombotic therapy and DOAC monotherapy significantly increase the risk of postoperative hemorrhage after dental extractions, suggesting preventive hospitalization may be considered for high-risk patients.
May warrant closer post-extraction monitoring on dual therapy; leaves open optimal strategies pending prospective trials.
BACKGROUND: The aim of this retrospective study was to identify high-risk dental extraction patients and the timing of postoperative hemorrhage to evaluate whether preventive hospitalization should be considered in patients on antiplatelet medication (AP) or anticoagulants. METHODS: Our study included 1595 procedures; 1319 were conducted under monotherapy (Group I: AP; Group II: indirect oral anticoagulant [IAC]; Group III: direct oral anticoagulant [DOAC]) and 276 under dual therapy (Group IV: double AP; Group V: AP and IAC; Group VI: AP and DOAC). We evaluated the incidence, frequency and timing of hemorrhage, hospitalization rate, and treatment of bleeding incidents. RESULTS: The incidence of hemorrhagic events was significantly higher in the dual therapy groups compared to the monotherapy groups (p < 0.001). Comparing the procedures under monotherapy, those on DOAC (Group III) had a significantly higher risk of postoperative bleeding than Groups I and II (p < 0.001) and a higher rate of repeated bleeding episodes (p = 0.035). Regarding bleeding incidents, 44% (dual therapy) vs. 51.1% (monotherapy) occurred on the day of surgery. CONCLUSIONS: The bleeding risk after dental extractions is overall low and patients were often hospitalized preventively due to their comorbidities rather than actual bleeding risk. Patients should be instructed about local compression, and surgeries should be completed in the morning to avoid emergency visits. However, patients with cardiovascular diseases and dual therapy had a higher risk of postoperative hemorrhage. Thus, hospitalization is to be considered in these cases. TRIAL REGISTRATION: The study was approved by the Ethics Committee of the Medical Faculty of RWTH Aachen (Decision Number 24-136). This was a retrospective clinical study designed to analyze postoperative bleeding and hospitalization rates after dental extractions in patients on AP or anticoagulation therapy.
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Katz et al. (2024) conducted a cohort in Dental extraction under antiplatelet or anticoagulation therapy (n=1,280). Dual antiplatelet or anticoagulation therapy vs. Monotherapy was evaluated on Postoperative bleeding events (OR 2.315, 95% CI 1.290-4.149, p=0.005). Dual antiplatelet or anticoagulation therapy significantly increased the risk of postoperative hemorrhage after dental extractions compared to monotherapy (OR 2.315), though overall bleeding rates remained low.
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