Severe Enoral Bleeding with a Direct Oral Anticoagulant after Tooth Extraction and Heparin Bridging Treatment

Ehrhard, Simone; Burkhard, John‐Patrik; Exadaktylos, Aristomenis K.; Sauter, Thomas C.

doi:10.1155/2019/6208604

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…Case reports are also available among the literature in the field. Ehrhard et al [ 18 ], for example, presents a case report from a patient taking apixaban where five dental extractions were performed in one clinical act, having previously administering a bridging therapy to the patient. The patient presented profuse bleeding after the extraction.…”

Section: Discussionmentioning

confidence: 99%

Bleeding Complications in Anticoagulated and/or Antiplatelet-Treated Patients at the Dental Office: A Retrospective Study

Martínez-Moreno

Martínez-López

Rodríguez‐Lozano

et al. 2021

IJERPH

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Background: Bleeding complications in patients undergoing antiplatelet and/or anticoagulant therapy have been one of the main concerns in dental practice. Upon the introduction of new antiplatelet and anticoagulant drugs, there is a search for new protocols that respond to a secure treatment. The aim of the present study was to evaluate bleeding complications in anticoagulated and antiplatelet-treated patients after performing simple dental extractions, in a period of 4 years. Material and Methods: 147 clinical records of anticoagulated and/or antiplatelet-treated patients undergoing a simple dental extraction over a period of 4 years (October 2015 to September 2019) were studied. Within the sample, 63 patients were antiplatelet-treated, 83 were anticoagulated, and 1 patient was under both therapies. Within the anticoagulated patients, 70 took classic anticoagulants and 14 new oral anticoagulants (NOACs). Quantitative data were studied with arithmetic mean and standard deviation (SD). The chi-square test was used for the qualitative variables. ANOVA tests were used to compare age and anticoagulated or antiplatelet-treated patients. Statistical significance was determined when p < 0.05. Results: From the 418 dental extractions performed, five severe bleeding complications took place in three patients (2.11%). From the five events, four were in patients treated with NOACs (1.68%) and one occurred in a patient anticoagulated with acenocoumarol (0.42%; p = 0.003). Conclusions: Considering the results of this retrospective clinical study, we can conclude that bleeding complications in anticoagulated and/or antiplatelet-treated patients after tooth extractions were low, with a higher incidence recorded in patients treated with NOACs, followed by classic anticoagulants, and there were no complications in antiplatelet-treated patients.

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Section: Discussionmentioning

confidence: 99%

Bleeding Complications in Anticoagulated and/or Antiplatelet-Treated Patients at the Dental Office: A Retrospective Study

Martínez-Moreno

Martínez-López

Rodríguez‐Lozano

et al. 2021

IJERPH

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“…There have been no published instances of significant bleeding following dental treatment for patients taking a DOAC. One paper discussed significant bleeding for a patient who had originally been taking a DOAC but had been switched to Heparin as a bridging agent for the extraction on that occasion (27). The bleeding was managed by local measures (27).…”

Section: Clinical Decision-making Based On Key Points From Published mentioning

confidence: 99%

“…One paper discussed significant bleeding for a patient who had originally been taking a DOAC but had been switched to Heparin as a bridging agent for the extraction on that occasion (27). The bleeding was managed by local measures (27). The risk of a thrombotic event when stopping a DOAC is not known as there is no clinical research to date.…”

Section: Clinical Decision-making Based On Key Points From Published mentioning

confidence: 99%

Managing an Ageing Population: Challenging Oral Epidemiology

et al. 2020

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Global population projections indicate that the proportion of older people is increasing and will continue to do so for the foreseeable future. Many countries are already experiencing the challenges of managing an ageing population, including increased pension contributions from workers, rises to national retirement ages, and spiralling healthcare costs. In oral health terms, in addition to simply an ageing population, epidemiological studies have demonstrated significant changes in the oral health of older adults in recent years. As the numbers of edentulous older adults has declined, there has been a significant increase in the number of partially dentate elderly. Changing attitudes, improved access to dental care and more effective preventative programmes have meant that large numbers of patients are now retaining natural teeth into old age. However, as older patients retain natural teeth for longer, the dental profession is charged with controlling chronic dental diseases in an increasingly challenging oral environment.

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“…27 The bleeding was managed by local measures. 27 The risk of a thrombotic event when stopping a DOAC is not known as there is no clinical research to date. It has been recognised with previous anticoagulants that interrupting therapy can result in a recurrence of a thromboembolic event.…”

Section: Uncontrolled Haemorrhagementioning

confidence: 99%

Managing Patients at Risk of Medication Related Complications Requiring Dental Extractions in Primary Care

2020

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When undertaking dental extractions in modern dental practice, two of the complications that have the potential to cause most apprehension for clinicians are the risks of osteonecrosis of the jaws and uncontrollable haemorrhage. This is especially the case when treating older patients because of the increased likelihood of co-morbidities and accompanying polypharmacy which can predispose patients to these problems. Specific medications of concern to practitioners in relation to osteonecrosis risk are antiangiogenic and antiresorptive drugs. Patients taking dual antiplatelet therapy and direct oral anticoagulants require consideration in relation to bleeding risk. With these medications coming increasingly to the forefront over recent years, guidance has been developed by organisations such as the Scottish Dental Clinical Effectiveness Programme (SDCEP). Appropriate use of these guideline should ensure that patients felt to be at particular risk of these complications can frequently be safely managed in primary care. This article aims to provide advice on recognising patients at risk, and to discuss how to utilise key messages within published guidelines when making treatment decisions. The overall intent is to help primary care clinicians who are likely to encounter these patients more and more.

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Severe Enoral Bleeding with a Direct Oral Anticoagulant after Tooth Extraction and Heparin Bridging Treatment

Cited by 9 publications

References 22 publications

Bleeding Complications in Anticoagulated and/or Antiplatelet-Treated Patients at the Dental Office: A Retrospective Study

Bleeding Complications in Anticoagulated and/or Antiplatelet-Treated Patients at the Dental Office: A Retrospective Study

Managing an Ageing Population: Challenging Oral Epidemiology

Managing Patients at Risk of Medication Related Complications Requiring Dental Extractions in Primary Care

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