Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study.
anticoagulants
antithrombins
factor Xa inhibitors
oral hemorrhage
tooth extraction
warfarin
Journal
Research and practice in thrombosis and haemostasis
ISSN: 2475-0379
Titre abrégé: Res Pract Thromb Haemost
Pays: United States
ID NLM: 101703775
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
09
09
2019
revised:
04
12
2019
accepted:
26
12
2019
entrez:
29
2
2020
pubmed:
29
2
2020
medline:
29
2
2020
Statut:
epublish
Résumé
Conflicting recommendations exist addressing the management of direct oral anticoagulants (DOACs) for invasive dental procedures. To determine the safety of DOAC continuation compared to warfarin continuation for dental extractions with regards to bleeding outcomes. 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. 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. 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.
Sections du résumé
BACKGROUND
BACKGROUND
Conflicting recommendations exist addressing the management of direct oral anticoagulants (DOACs) for invasive dental procedures.
OBJECTIVES
OBJECTIVE
To determine the safety of DOAC continuation compared to warfarin continuation for dental extractions with regards to bleeding outcomes.
METHODS
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 32110759
doi: 10.1002/rth2.12307
pii: S2475-0379(22)01982-3
pmc: PMC7040537
doi:
Types de publication
Journal Article
Langues
eng
Pagination
278-284Informations de copyright
© 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals, Inc on behalf of International Society on Thrombosis and Haemostasis.
Références
Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Nov;122(5):e146-e155
pubmed: 27554378
Chest. 2016 Feb;149(2):315-352
pubmed: 26867832
JAMA Intern Med. 2019 Nov 01;179(11):1469-1478
pubmed: 31380891
Med Oral Patol Oral Cir Bucal. 2017 Nov 1;22(6):e767-e773
pubmed: 29053656
Chest. 2012 Feb;141(2 Suppl):e326S-e350S
pubmed: 22315266
Anaesth Crit Care Pain Med. 2017 Feb;36(1):73-76
pubmed: 27659969
J Thromb Haemost. 2010 Jan;8(1):202-4
pubmed: 19878532
Int J Oral Maxillofac Surg. 2019 Aug;48(8):1102-1108
pubmed: 30745243
Clin Oral Investig. 2019 Aug;23(8):3183-3192
pubmed: 30392079
Intern Med J. 2014 Jun;44(6):525-36
pubmed: 24946813
Kardiol Pol. 2018;76(9):1283-1298
pubmed: 30211938
Stat Med. 1998 Apr 30;17(8):857-72
pubmed: 9595616
Br Dent J. 2017 Feb 24;222(4):245-249
pubmed: 28232717
Heart Rhythm. 2019 Aug;16(8):e66-e93
pubmed: 30703530
Semin Thromb Hemost. 2019 Mar;45(2):171-179
pubmed: 30743279
Res Pract Thromb Haemost. 2020 Feb 11;4(2):278-284
pubmed: 32110759
Int J Oral Maxillofac Surg. 2018 Jul;47(7):940-946
pubmed: 29653869