Objective: To examine the effects of direct oral anticoagulants (DOACs) on bleeding complications following dental surgeries. Subjects and Methods:This 6-year retrospective study collected data from records of patients undergoing oral surgical procedures within a university setting. An electronic health record database was searched using current procedural terminology codes for oral surgical procedures. Information regarding patient, procedural factors, and postoperative complications were extracted. Data were analyzed by Fisher's exact test. Results:Of patients who had a procedural code associated with oral surgery, only 0.11% (12/11,320) took a DOAC. Twelve patients (10 males, age ranging from 44 to 90 years) underwent 17 surgeries by nine different practitioners involving 98 extractions, 14 alveoloplasties, two tuberosity reductions, and two tori removals. In nine cases, the DOAC was discontinued a mean of 52.5 hrs prior to surgery (range 12-120 hrs). Bleeding complications were not reported for patients whose drug was discontinued or continued. Documentation of drug continuation/discontinuation was poor. Conclusions:Bleeding was not observed with direct oral anticoagulation use in this oral surgery cohort. Drug discontinuation/continuation was not a factor in bleeding outcomes, and direct oral anticoagulation interruption was variable and poorly documented. K E Y W O R D Santicoagulants, bleeding, oral surgery, tooth extraction | INTRODUCTIONSince 2010, four direct oral anticoagulant (DOAC) drugs (ie, dabigatran, rivaroxaban, apixaban, and edoxaban) have been approved by the Food and Drug Administration. These drugs antagonize specific coagulation proteins (ie, Factor Xa and thrombin), which contribute to their pharmacological utility in preventing blood clots and strokes in patients who have atrial fibrillation. A main complication of DOAC use is bleeding. Current data indicate that DOACs demonstrate similar gastrointestinal bleeding rates (Spencer & Amerena, 2015) and lower major extra-cranial bleeding rates compared with warfarin (Connolly et al., 2009;Lee, 2016). The relationship of DOACs with dental procedure-related perioperative and postoperative bleeding is less well defined.At present, there are a limited number of clinical studies that have examined the use of DOACs and bleeding in association with invasive dental procedures. The two largest studies, the RE-LY and ARISTOTLE, reported on bleeding and dental procedures associated with dabigatran (n = 459) and apixaban (n = 1,435), respectively (Garcia et al., 2014;Healey et al., 2012). These studies while valuable do not specify the invasiveness and type of dental procedures performed, whether the DOAC was discontinued before the procedure and the relationship 244 | MILLER and MILLER of these factors to the frequency of major and minor bleeding. As a result, we depend on expert opinions (Albaladejo et al., 2017;Elad, Marshall, Meyerowitz, & Connolly, 2016;Firriolo & Hupp, 2012;Little, 2012;van Ryn et al., 2010) and smaller clinical studies to provide...