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

Khaheshi, Isa; Hoseinzadeh, Afshin; Rezvanpour, Babak; Shafie, Sherif El

doi:10.1016/j.joms.2018.04.036

Cited by 10 publications

(9 citation statements)

References 17 publications

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“…Additionally, because reversal of the irreversible effect of antiplatelet agents is not expected to occur until the life span of platelets has expired, discontinuation for dental surgery with increasing thromboembolic risk cannot be justified. Moreover, no significant differences in the frequency of postoperative bleeding after dental surgery can be observed when discontinuing or continuing APT [15,[21][22][23]. In this study, the patients did not interrupt the APT, and we did not observe significant postoperative bleeding events between the APT and DOAC/VK groups.…”

Section: Discussionmentioning

confidence: 62%

A prospective comparative study to assess the risk of postoperative bleeding after dental surgery while on medication with direct oral anticoagulants, antiplatelet agents, or vitamin K antagonists

et al. 2021

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Background The aim of this prospective study was to investigate the occurrence and severity of postoperative bleeding following dentoalveolar surgery in patients with uninterrupted anticoagulation therapy (AT). Methods Patients receiving AT (vitamin k antagonist (VK), direct oral anticoagulants (DOAC) or antiplatelet therapy (APT) and in need of surgical intervention classified as A, B or C (single or serial tooth extraction, osteotomy, or implant placement) were studied between 2019 and 2021. A healthy, non-anticoagulated cohort (CG) served as a control group. The main outcomes measured were the frequency of postoperative bleeding, the classification of the severity of postoperative bleeding (1a, 1b, 1c, 2, 3), and the correlation with the AT surgical intervention classification. Results In total, 195 patients were included in the study, with 95 patients in the AT group and 100 in the CG. Postoperative bleeding was significant in the AT group vs. the CG (p = 0.000), with a significant correlation with surgical intervention class C (p = 0.013) and the severity class of bleeding 1a (p = 0.044). There was no significant correlation with procedures of type A, B or C for the other postoperative bleeding gradations (1b, 1c, 2 and 3). There was a statistically significant difference in the occurrence of postoperative bleeding events between the DOAC/APT group and the VK group (p = 0.036), but there were no significant differences regarding the other AT agents. Conclusion The continuation of anticoagulation therapy for surgical interventions also seems reasonable for high-risk interventions. Although significantly more postoperative bleeding occurs, the severity of bleeding is low. The perioperative management of anticoagulated patients requires well-coordinated interdisciplinary teamwork and detailed instruction of patients. Clinical trial registration The study is registered (29.03.2021) at the German clinical trial registry (DRKS00024889).

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Section: Discussionmentioning

confidence: 62%

A prospective comparative study to assess the risk of postoperative bleeding after dental surgery while on medication with direct oral anticoagulants, antiplatelet agents, or vitamin K antagonists

et al. 2021

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“…A case-and-crossover study. 32 Influence of platelet-poor plasma on angiogenesis and maintenance of volume in autogenous bone grafts. 33 Implant-supported hybrid prosthesis for severe mandibular defects: a sequence of treatments from alveolar distraction osteogenesis to implant restoration.…”

Section: Resultsmentioning

confidence: 99%

“…A BIBLIOMETRIC ANALYSIS: "DENTAL IMPLANTS" SECTION OF THE JOMS J DIAGN TREAT ORAL MAXILLOFAC PATHOL 2020; 4(2):[25][26][27][28][29][30][31][32][33][34][35][36][37] …”

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confidence: 99%

February’s 2020 Full Issue PDF

2020

J. Diagn. Treat. Oral Maxillofac. Pathol.

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This is a monthly peer-reviewed oral and maxillofacial surgery journal focused on: Microvascular and jaw reconstructive surgery, dental implants, salivary gland tumors/diseases, TMJ lesions, virtual surgical planning, implementation of ultrasonography into the practice of oral and maxillofacial surgeons. Editorial Board (EB) CompositionEB shows significant geographic diversity representing 24 opinion leaders from 13 countries: Brazil,

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“…Doganay et al, in 2018, assessed the risk of bleeding in patients taking ticagrelor. In addition, in this case the risk of postoperative bleeding was declared minimum or acceptable, in patients undergoing dental extractions or small oral surgery maneuvers [34,35], according to the authors, patients can undergo oral surgery safely. Patients undergoing oral surgery in the Rocha et al 2018, study did not change their antithrombotic therapy, as this is not a risk factor for the patient [36].…”

Section: Discussionmentioning

confidence: 99%

“…The dentist, even in patients undergoing therapy, can perform routine extraction without risk without interrupting or modifying the latter. Patients do not have a greater risk of bleeding, even if they have been in antiplatelet therapy for a long time but, in some cases, as some authors mention in a refined way, the therapy must be personalized for each patient [26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42] Pototski et al in 2007, stated in their work that patients can be treated without risk if their INR is lower than 4.0 [48]. However, other studies assess that the risk of bleeding can be controlled by post-extraction hemostasis maneuvers [49].…”

Section: Discussionmentioning

confidence: 99%

Advances in Antiplatelet Therapy for Dentofacial Surgery Patients: Focus on Past and Present Strategies

et al. 2019

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Background: Nowadays, patients involved in antiplatelet therapy required special attention during oral surgery procedures, due to the antiplatelet drugs assumption. The motivations of the assumption may be different and related to the patient’s different systemic condition. For this reason, accordingly to the current international guidelines, different protocols can be followed. The aim of this work is to analyze how the dentist’s approach to these patients has changed from the past to the present, evaluating the risk exposure for the patients. Methods: This review paper considered different published papers in literature through quoted scientific channels, going in search of “ancient” works in such a way as to highlight the differences in the protocols undertaken. The analyzed manuscripts are in the English language, taking into consideration reviews, case reports, and case series in such a way as to extrapolate a sufficient amount of data and for evaluating the past therapeutic approaches compared to those of today. Results: Colleagues in the past preferred to subject patients to substitution therapy with low molecular weight anticoagulants, by suspending antiplatelet agents to treatment patients, often for an arbitrary number of days. The new guidelines clarify everything, without highlighting an increased risk of bleeding during simple oral surgery in patients undergoing antiplatelet therapy. Conclusion: Either patients take these medications for different reasons, because of cardiovascular pathologies, recent cardiovascular events, or even for simple prevention, although the latest research shows that there is no decrease of cardiovascular accidents in patients who carry out preventive therapy. Surely, it will be at the expense of the doctor to assess the patient’s situation and risk according to the guidelines. For simple oral surgery, it is not necessary to stop therapy with antiplatelet agents because the risk of bleeding has not increased, and is localized to a post-extraction alveolus or to an implant preparation, compared to patients who do not carry out this therapy. From an analysis of the results it emerges that the substitutive therapy should no longer be performed and that it is possible to perform oral surgery safely in patients who take antiplatelet drugs, after a thorough medical history. Furthermore, by suspending therapy, we expose our patients to more serious risks, concerning their main pathology, where present.

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

Abstract: The results suggest that continuing the intake of antiplatelet drugs did not increase bleeding after placement of dental implants.

Cited by 10 publications

References 17 publications

A prospective comparative study to assess the risk of postoperative bleeding after dental surgery while on medication with direct oral anticoagulants, antiplatelet agents, or vitamin K antagonists

A prospective comparative study to assess the risk of postoperative bleeding after dental surgery while on medication with direct oral anticoagulants, antiplatelet agents, or vitamin K antagonists

February’s 2020 Full Issue PDF

Advances in Antiplatelet Therapy for Dentofacial Surgery Patients: Focus on Past and Present Strategies

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