Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis

Ockerman, Anna; Bornstein, Michael M.; Leung, Yiu Yan; Li, S.K.Y.; Politis, Constantinus; Jacobs, Reinhilde

doi:10.1016/j.ijom.2019.06.002

Cited by 23 publications

(7 citation statements)

References 31 publications

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“…The postoperative bleeding risk was significantly elevated for DAPT compared to SAPT and no APT, but only by 1% and 1%, respectively. [ 16 ] Clinically, this may be considered quite similar. In addition, local haemostatic measures could control all reported bleeding and no lethal events occurred.…”

Section: Discussionmentioning

confidence: 97%

Assessment of postoperative bleeding after dental extractions in patients who are on antiplatelet therapy: A prospective study

Hoda

Navaneetham

Sham

et al. 2021

Ann Maxillofac Surg

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Introduction: Patients with ischemic heart disease are placed on antiplatelet therapy (APT). This study allows a definite protocol to be set which will allow us the make the right judgment when it comes to extractions in patients on APT. Materials and Methods: For this study, 100 patients were taken up for dental extraction after obtaining a thorough case history. Bleeding time was assessed preoperatively for all the patients and patients with normal bleeding time were taken up for surgery under local anesthesia. Local haemostatic measures were employed after the extraction. Patients were monitored for first 30 minutes at the clinic and a telephonic review of all the patients was done at 24 h–48 h interval after the procedure. If there was an active ooze from the surgical site at any point, haemostatic measures with local haemostatic agents were carried out. Results: In patients with mono antiplatelet therapy, bleeding was noted in 16 patients after the 1 h time interval and was absent after 24h–48 h time intervals. The q = 32 and the P < 0.001, making it statistically significant. Regarding patients on dual APT, bleeding was noted in ten patients after 1 h, and in one patient after 24 h with no patients presenting with bleeding at the 48 h time interval. The q = 16.545 and P < 0.001, making it statistically significant. Discussion: The benefits of continuing APT for patients who require dental extraction outweighs the risks of postoperative bleeding. Conclusion: Antiplatelets are used for the prevention of myocardial infarction, ischemic stroke, and vascular death among patients who are at high risk of these events. Antiplatelets have minimal impact on the amount and duration of bleeding following routine dental extractions.

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Section: Discussionmentioning

confidence: 97%

Assessment of postoperative bleeding after dental extractions in patients who are on antiplatelet therapy: A prospective study

Hoda

Navaneetham

Sham

et al. 2021

Ann Maxillofac Surg

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“…On the contrary, serious complications like early mortality and repeat laparotomy were significantly increased in the lymphadenectomy group ( 42 ). Indeed, a significant limitation of retroperitoneal lymphadenectomy is the potential for several intraoperative and postoperative complications, like hemorrhage, sepsis, vascular injury, lymphocysts, intestinal or chylous fistula, lower limb edema, pulmonary embolism, repeat laparotomy and post-operative mortality ( 43 ). Therefore, it is important to clarify the role of this procedure especially in ESOC.…”

Section: Discussionmentioning

confidence: 99%

Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis

Yao

Jin

2021

Front. Surg.

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Objective: The study aimed to assess if additional lymphadenectomy with primary staging surgery improves overall survival (OS) and disease-free survival (DFS) of early-stage ovarian cancer (ESOC).Methods: PubMed and Embase databases were searched for any type of study comparing OS or DFS between lymphadenectomy and control groups for any type of ESOC. Adjusted hazard ratios (HR) were pooled in a random-effects model.Results: Twelve studies were included. Meta-analysis indicated that lymphadenectomy is associated with significantly improved OS only for epithelial tumors (HR 0.75 95% CI 0.68, 0.82 I2 = 0% p < 0.00001) but not for malignant germ cell tumors (HR 1.31 95% CI 0.88, 1.94 I2 = 0% p = 0.18). Single studies indicated a tendency of improved OS with lymphadenectomy which was significant for ovarian carcinosarcoma but not for sex cord-stromal tumors. On meta-regression of all histological types, the percentage of patients with lymph node metastasis in the lymphadenectomy group was not found to influence the effect size. Meta-analysis also indicated that lymphadenectomy is associated with significantly improved DFS for epithelial tumors (HR 0.59 95% CI 0.45, 0.77 I2 = 0% p < 0.0001). Single studies on malignant germ cell and sex cord-stromal tumors failed to demonstrate any significant beneficial effect of lymphadenectomy on DFS.Conclusions: Within the limitations of the review, lymphadenectomy may improve OS and DFS for epithelial ESOC. Scarce data suggest that lymphadenectomy is not associated with improved outcomes for malignant germ cell and sex cord-stromal tumors but may benefit ovarian carcinosarcoma. Large-scale RCTs and robust observational studies shall improve current evidence.

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“…Any disagreements in the study selection process were resolved by discussion with the third reviewer (WH). To avoid any missed studies, the bibliography of included studies and recent reviews (Yang et al, 2016;Shi et al, 2017;De Andrade et al, 2019;Ockerman et al, 2020) on the topic were hand searched for any additional references.…”

Section: Search Strategymentioning

confidence: 99%

Bleeding Outcomes After Dental Extraction in Patients Under Direct-Acting Oral Anticoagulants vs. Vitamin K Antagonists: A Systematic Review and Meta-Analysis

Hua

Huang

2021

Front. Pharmacol.

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Background: The current systematic review aimed to compare bleeding outcomes in dental extraction patients receiving uninterrupted Direct-acting oral anticoagulant (DOAC) or Vitamin K antagonists (VKAs) for various systemic diseases.Methods: PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched for randomized controlled trials, controlled clinical trials, prospective and retrospective cohort studies, and case control studies, conducted on adult patients undergoing dental extraction under uninterrupted DOAC or VKAs therapy and reporting bleeding outcomes. The search was conducted up to March 31, 2021. We pooled data to calculate risk ratios (RR) with 95% confidence intervals (CI) in a random-effects model.Results: Eight studies comparing 539 patients on DOAC therapy and 574 patients on VKAs were included. Meta-analysis indicated a statistically significant lower bleeding risk in patients under DOAC therapy (RR 0.68 95% CI 0.49, 0.95 I2 = 0%). However, on sensitivity analysis, the results were statistically non-significant after exclusion of any of the included studies. On pooled analysis of limited number of studies, we found no statistically significant difference in the risk of bleeding between apixaban (RR 0.85 95% CI 0.45, 1.60 I2 = 0%), rivaroxaban (RR 0.95 95% CI 0.36, 2.48 I2 = 45%), dabigatran (RR 0.49 95% CI 0.19, 1.28 I2 = 5%), edoxaban (RR 0.41 95% CI 0.13, 1.27 I2 = 0%) and VKAs.Conclusion: The results of the first review comparing bleeding outcomes after dental extraction in patients on uninterrupted DOAC or VKA therapy indicates that patients on DOAC may have a reduced risk of hemorrhage. Current evidence is of very low-quality and should be interpreted with caution. Data on individual DOAC is scarce and at this point, the difference in the risk of bleeding between these drugs cannot be elucidated. Further studies with a large sample size shall supplement our conclusion.

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Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis

Cited by 23 publications

References 31 publications

Assessment of postoperative bleeding after dental extractions in patients who are on antiplatelet therapy: A prospective study

Assessment of postoperative bleeding after dental extractions in patients who are on antiplatelet therapy: A prospective study

Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis

Bleeding Outcomes After Dental Extraction in Patients Under Direct-Acting Oral Anticoagulants vs. Vitamin K Antagonists: A Systematic Review and Meta-Analysis

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