Bleeding events after simple dental extraction among patients undergoing anticoagulation therapy: cohort prospective comparative study

Aim: The aim of the study is to evaluate and compare the intra- and post-operative bleeding during asimple dental extraction, among patients undergoing conventional Oral Anticoagulant Therapy (OAT) and patients assuming Direct Oral Anticoagulants (DOACs). Methods: Patients in chronic oral anticoagulant therapy (at least 6 months) with indication of a single dental extraction were enrolled and divided between OAT e DOACs group. All the participants were evaluated at four different time-points: T0 during the first examination, T1 during surgery, T2 thirty minutes after surgery and T3 the day of suture removal (seven days after surgery). At the different time-points anagraphic, medical history, local periodontal and dental variables were collected. The surgical protocol consisted in a simple dental extraction lead by the same surgeon (FB), in the least invasive procedure. Bleeding occurrence and biological complications were registered, according to Iwabuchi classification. Results: 15 patients (mean age 77,27±5,72) and 18 patients (mean age 75,94±12,18) were enrolled respectively in OAT e DOACs group. Overall 33 teeth were extracted within 20 minutes of surgical time (cut off that defined the simple extraction in our research protocol). The results of the present study showed no statistical difference between the two groups regarding the intraoperative bleeding and post-extraction bleeding complications. In detail, no intra-operative bleeding occurred, two patients for each group reported a post-operative bleeding managed with a single gauze compression during the week after the extraction, three patients of OAT group and one subject belonging to DOACs group needed more than two compressions in the week, and finally one patient for each group referred to our dental first aid. In these two cases, the urgency was managed with the local application of tranexamic acid and the complication could be attributable to high blood pressure values. Conclusion: Within the limits of the present study, apparently, patients assuming DOACs can be treated for simple oral surgery like patients undergoing OAT with INR index in therapeutic range. No discontinuation or changes of anticoagulation treatment with novel oral anticoagulants are possibly required. The adoption of local hemostasis techniques represents the most important precaution to prevent bleeding complications and to discriminate between bleeding caused by anticoagulation therapy and surgical technique. The patient education for the post-operative care of surgical site appears also strictly necessary.