Delayed bleeding after implant surgery in patients taking novel oral anticoagulants: a case report

Abstract

The use of novel oral anticoagulants (NOACs) has increased in recent times in an effort to overcome the shortcomings of warfarin. They are being used primarily for the prevention of thrombosis caused by atrial fibrillation and offer the advantages of having fewer drug interactions than warfarin, no dietary restrictions, and no requirement for regular blood tests. Although there is reportedly less postoperative bleeding even if the drug is not discontinued during procedures that can cause local bleeding, such as dental procedures, no well-designed clinical studies have assessed postoperative bleeding associated with the use of these drugs. This article reports a case of a 74-year-old male patient who was taking rivaroxaban. The patient underwent a dental implant procedure after discontinuing rivaroxaban for one day and subsequently suffered delayed bleeding on postoperative day 6. Accordingly, this article also reports that the use of NOACs may also lead to delayed bleeding.

Do Antiplatelet Drugs Increase the Risk of Bleeding After Dental Implant Surgery? A Case-and-Crossover Study

“…Another study reported delayed bleeding in patients using rivaroxaban and who underwent dental implant placement 1 day after discontinuing the anticoagulant. 13 Clopidogrel is an antithrombotic drug that inhibits platelet function by irreversibly binding to the platelet receptor, P2Y12, and therefore prevents the binding of ADP. 14 Furthermore, P2Y12 is 1 of 2 platelet receptors for ADP, which is important in the pathogenesis of arterial thrombi through ADP-induced platelet aggregation and the potentiation of platelet secretion induced by strong agonists.…”

Dental implants and bleeding disorders: review and clinical indications

“…Among twenty-six articles: four were case reports [43][44][45][46], one was a case series [47], six were cohort studies[8, 31, 48-51], eight were case control studies [33][34][35][36][52][53][54][55], six were reviews [40,[56][57][58][59][60] and one was an animal study.…”

“…Considering the clinical studies, five authors treated patients undergoing conventional anticoagulant drugs [8, 44,45,48,53]; six treated patients using DOAC [43,47,49,51,54,55] and in the remaining articles the sample considered used both medications [31,[33][34][35][36]52].…”

“…However, in every clinical study, where a haemorrhagic complication occurred, it was always solved with the only help of local hemostatic measurements [33,34,36,43,48,49,[51][52][53][54][55]. The only animal study investigated the effects of Rivaroxaban on osteointegration and it showed that it did not effect it.…”

The New Oral Anticoagulants (NOACs) Between Prevention of Systemic Thromboembolism and Bleeding Procedures in the Dental Office: Review of Literature and Case Report

“…Miclotte et al [25] conducted a prospective cohort study on 52 patients and indicated the elimination of the morning dose of Dabigatran, Rivaroxaban and Apixaban prior to the intervention, even though the postoperative bleeding risk might be slightly higher [25]. Based on the case of a patient under treatment with Rivaroxaban who had multiple minor bleeding episodes several days after the dental implant surgery, C Kim et al indicated the cessation of NOACs [26]. Recently, in a review published in 2018 by K Fortier et al, the cessation of Dabigatran, Rivaroxaban, Apixaban and Edoxaban was indicated in all dental surgery interventions, regardless of the high or low risk of bleeding [27][28][29].…”