Direct Oral Anticoagulants and Medical Comorbidities in Patients Needing Dental Extractions: Management of the Risk of Bleeding
| Autor: | Stefano Carossa, Nadia Cocero, Michele Basso, Simona Grosso |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Molar
Excessive Bleeding medicine.medical_specialty Surgery Oral Surgery Otorhinolaryngology Pathology and Forensic Medicine Administration Oral Hemorrhage Comorbidity Pathology and Forensic Medicine 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus medicine Humans In patient Retrospective Studies business.industry Incidence (epidemiology) Anticoagulants Retrospective cohort study 030206 dentistry medicine.disease Otorhinolaryngology 030220 oncology & carcinogenesis TOOTH EXTRACTIONS Tooth Extraction business |
| Zdroj: | Journal of Oral and Maxillofacial Surgery. 77:463-470 |
| ISSN: | 0278-2391 |
| Popis: | Purpose The purpose of this study was to measure the frequency of bleeding during and after tooth extraction in patients exposed to direct oral anticoagulants (DOACs) and identify risk factors for prolonged or excessive bleeding. Materials and Methods This retrospective cohort study involved 100 patients who underwent tooth extractions according to the European Heart Rhythm Association protocol: continuation of DOAC therapy for extractions of up to 3 teeth in the same session performed at the (presumed) time of DOAC trough concentration. We respected an interval of at least 4 hours between extraction and last DOAC intake. The outcome of interest was incidence of mild, moderate, and severe bleeding during the intervention and in the 7-day follow-up period. Data analysis considered the presence of comorbidities as the primary predictor for bleeding; additional predictors were age, gender, type of comorbidity, indication for DOAC therapy, DOAC agent, and extraction of contiguous teeth. Results Of the patients, 64 had comorbidities (diabetes in 50%). The distributions of demographic, clinical, and dental variables were similar for patients with and without comorbidities. We observed 4 bleeding episodes (1 moderate episode 1 hour after the extraction and 3 mild episodes the day after the extraction) in the comorbidity group and none in the non-comorbidity group (4 of 64 vs 0 of 36, P = .29; overall bleeding rate, 4 of 100). The factor significantly triggering bleeding in patients with comorbidity was extractions of couples and triplets of multirooted teeth (P = .004). Conclusions Tooth extractions in patients with comorbidities taking DOACs may be safely managed as long as they are performed at least 4 hours after the last DOAC intake and do not involve 2 or 3 contiguous premolars and molars. |
| Databáze: | OpenAIRE |
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