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. 2020 Feb 11;4(2):278-284.
doi: 10.1002/rth2.12307. eCollection 2020 Feb.

Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study

Yvonne Brennan  1   2 , Ying Gu  3 , Mark Schifter  3   4 , Helen Crowther  1   5 , Emmanuel J Favaloro  6   7 , Jennifer Curnow  1   2   7
Affiliations

Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study

Yvonne Brennan et al. Res Pract Thromb Haemost. .

Abstract

Background: Conflicting recommendations exist addressing the management of direct oral anticoagulants (DOACs) for invasive dental procedures.

Objectives: To determine the safety of DOAC continuation compared to warfarin continuation for dental extractions with regards to bleeding outcomes.

Methods: A single-center, prospective, cohort study was performed to compare 7-day bleeding outcomes between patients who continued their DOAC, and patients on warfarin with an International Normalized Ratio (INR) between 2.0 and 4.0. Blood tests including oral anticoagulant drug levels were measured immediately prior to extraction. The gauze used to apply pressure to the socket was weighed before and after extraction to estimate blood loss. Patients were contacted by phone 2 and 7 days after extraction.

Results: Eighty-six patients on a DOAC had a total of 145 teeth extracted, and 21 patients on warfarin had 50 teeth extracted. There were no major bleeding events. The rate of minor plus clinically relevant nonmajor bleeding was comparable between the DOAC and warfarin cohorts (36% and 43%, respectively; odds ratio, 0.75; 95% confidence interval, 0.29-1.98). Preextraction apixaban and dabigatran levels were comparable between bleeders and nonbleeders, while rivaroxaban levels were higher in those who bled. The weight change of gauze used to tamponade the socket was similar between the 2 cohorts.

Conclusion: Dental extractions on patients continuing DOACs led to bleeding rates similar to patients on warfarin with an INR between 2.0 and 4.0. There is no need to adjust DOAC dosing prior to dental extractions.

Keywords: anticoagulants; antithrombins; factor Xa inhibitors; oral hemorrhage; tooth extraction; warfarin.

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References

    1. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society. Heart Rhythm. 2019;16:e66‐e93. - PubMed
    1. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149:315‐52. - PubMed
    1. Brennan Y, Favaloro EJ, Curnow J. To maintain or cease non‐vitamin K antagonist oral anticoagulants prior to minimal bleeding risk procedures: a review of evidence and recommendations. Semin Thromb Hemost. 2019;45:171‐9. - PubMed
    1. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence‐Based Clinical Practice Guidelines. Chest. 2012;141:e326S‐e350S. - PMC - PubMed
    1. Therapeutic Guidelines Limited . Therapeutic Guidelines: Oral and Dental, version 2. In: eTG Complete. 2017. [Accessed 20 August 2019.] Available from https://tgldcdp.tg.org.au.acs.hcn.com.au