Postoperative bleeding after dental extraction among elderly patients under anticoagulant therapy

• Published in: Clinical oral investigations 2021-04, Vol.25 (4), p.2363-2371
• Main Authors: Inokoshi, Masanao, Kubota, Kazumasa, Yamaga, Eijiro, Ueda, Kaori, Minakuchi, Shunsuke
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Anticoagulants; Anticoagulants - adverse effects; Atrial Fibrillation - drug therapy; Bleeding; Dentistry; Hemorrhage; Humans; Medicine; Original Article; Retrospective Studies; Rivaroxaban - adverse effects; Stroke - drug therapy; Tooth Extraction - adverse effects; Warfarin
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-020-03559-z

Objectives This study aimed to assess and compare postoperative bleeding occurrence after dental extraction in medically compromised elderly patients under anticoagulant therapy. Materials and methods This retrospective study included medically compromised elderly patients aged ≥ 65 years who were taking apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin and had undergone single or multiple dental extractions. The primary outcome measure was postoperative bleeding occurrence, which was defined as oozing or marked hemorrhage from 24 h to 7 days after dental extraction. Postoperative bleeding occurrence was calculated for each anticoagulant and compared using Fisher’s exact test, followed by multiple comparisons. Results Two hundred thirty-two patients met the inclusion criteria. The highest postoperative bleeding occurrence was recorded for rivaroxaban (12/37: 32.4%), followed by apixaban (8/44: 18.2%), warfarin (17/98: 17.3%), and edoxaban (2/35: 5.7%). Patients taking dabigatran did not present postoperative bleeding (0/18: 0%). Fisher’s exact test, followed by multiple comparison tests, revealed a significant among-anticoagulant difference ( p  = 0.0095). Postoperative bleeding was significantly higher in patients taking rivaroxaban than in those taking edoxaban or dabigatran ( p  = 0.03088). Conclusions Within the limitations of this retrospective study design, these findings suggest that different anticoagulants may affect postoperative bleeding occurrence after dental extraction among medically compromised elderly patients. Clinical relevance Clinicians should carefully consider postoperative bleeding after dental extraction in patients taking anticoagulant therapy, especially rivaroxaban.