Review: An overview and analysis of novel oral anticoagulants and their dental implications

The objective of this systematic review is to assess the risk of postoperative bleeding in oral surgery for implant placement in individuals taking antithrombotics (i.e., anticoagulants and/or antiplatelet agents). A literature search was performed in PubMed (MEDLINE), Web of Science, Scopus, and EMBASE databases for articles published until August 2020, with no date restriction, and manually completed. We included prospective clinical studies that provided information regarding the presence of an experimental group (i.e., implant placement), a control group (patients not under treatment with antithrombotics), and a well-established protocol for evaluating bleeding. Meta-analysis determined the risk of bleeding during the placement of implants in antithrombotic-treated patients. Of the 756 potentially eligible articles, 5 were included in the analysis with 4 ranked as high and 1 as medium quality. Antithrombotic treatment comprised the following drug classes: (1) anticoagulants: vitamin K antagonists, (2) nonvitamin K antagonist oral anticoagulants, (3) low-molecular-weight heparin, and (4) antiplatelet agents (not specified). The results suggest that the risk of bleeding is not substantially higher in antithrombotic-treated patients (odds ratio = 2.19; 95% confidence interval: 0.88–5.44, p = 0.09) compared with nontreated patients. This systematic review suggests that the absolute risk is low and there is no need to discontinue or alter the dose of the antithrombotic treatment for implant placement surgery.

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“…In the end, five articles could be included as they met the inclusion criteria (►Fig. 1). ►Table 1 describes the selected studies.…”

Section: Resultsmentioning

confidence: 99%

Risk of Bleeding during Implant Surgery in Patients Taking Antithrombotics: A Systematic Review

Miziara

Sendyk

Ortega

et al. 2021

Semin Thromb Hemost

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“…Several randomized trials demonstrated that canceling DAPT therapy increase the risk of stent thrombosis which can occur in short period of time or as a late complication [2,26,27]. It is associated with a high rate of myocardial infarction and a short-term mortality rate of up to 50-70% [2,17].…”

Section: Discussionmentioning

confidence: 99%

“…Withdrawing anticoagulant therapy could lead to ischemic stroke potentially resulting in disability or death. Therefore, maintaining both therapies is vital in the prevention of major adverse cardiac events [26][27][28][29]. Although both DAPT and NOAC therapy might cause bleeding complications.…”

Section: Discussionmentioning

confidence: 99%

“…Careful patients selection is essential for preventing complications. Basic categorization of dental procedures to low-bleeding and high-bleeding risk groups might be helpful in avoiding complications [26][27][28][29]. It seems that a case-by-case approach seems necessary in individual patients based not only on local bleeding risk related to dental procedure but also thrombotic/bleeding risk related to cardiovascular disease [30].…”

Section: Discussionmentioning

confidence: 99%

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Knowledge on the guideline-recommended use of antiplatelet and anticoagulant therapy during dental extractions: a contemporary survey among Polish dentists

Tokarek¹,

Homaj²,

Zabojszcz³

et al. 2020

Kardiol Pol

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“…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].…”

Section: Mrd000576 3(5)2019mentioning

confidence: 99%

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

Ilea¹,

Andrei²,

Am³

et al. 2019

MRD

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There is insufficient data on the use of NOACs during bleeding procedures in the dental office versus old oral anticoagulants. The current therapeutic indications are mostly based on the pharmacodynamics or on small cohort studies. Data from the literature has been reviewed in this respect. A 62-year-old patient under treatment with Rivaroxaban complained of transitory pain in the posterior upper-right jaw. The extraction of second upper right molar was performed, followed by the suture of the socket. According to the therapeutic indications and the available literature on the subject, the administration of the anticoagulant was not ceased. In the following days, repeated bleeding episodes were reported in direct correlation with the timing of Rivaroxaban administration and dose reduction was required to stop post-operative bleeding.Thus, the effect of NOACs could be unpredictable, as shown in the present case report. Therefore, further clinical research on the subject is needed.

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Review: An overview and analysis of novel oral anticoagulants and their dental implications

Abstract: Despite these benefits, as well as various others, NOACs still lack specific management parameters as well as antidotes or reversal agents. Therefore, dental professionals must use caution when treating patients currently taking these specific anticoagulants.

Cited by 16 publications

References 28 publications

Risk of Bleeding during Implant Surgery in Patients Taking Antithrombotics: A Systematic Review

Risk of Bleeding during Implant Surgery in Patients Taking Antithrombotics: A Systematic Review

Knowledge on the guideline-recommended use of antiplatelet and anticoagulant therapy during dental extractions: a contemporary survey among Polish dentists

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

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