Risk of bleeding after dental extractions rather low among patients on antiplatelet therapy, suggests study

This retrospective study aimed to identify high-risk dental extraction patients and the timing of postoperative haemorrhage to evaluate whether preventive hospitalization should be considered in patients on antiplatelet medication (AP) or anticoagulants.

The study included 1595 procedures; 1319 were conducted under monotherapy (Group I: AP; Group II: indirect oral anticoagulant [IAC]; Group III: direct oral anticoagulant [DOAC]) and 276 under dual therapy (Group IV: double AP; Group V: AP and IAC; Group VI: AP and DOAC).

We evaluated the incidence, frequency and timing of haemorrhage, hospitalization rate, and treatment of bleeding incidents.

Results: The incidence of hemorrhagic events was significantly higher in the dual therapy groups compared to the monotherapy groups (p < 0.001). Comparing the procedures under monotherapy, those on DOAC (Group III) had a significantly higher risk of postoperative bleeding than Groups I and II (p < 0.001) and a higher rate of repeated bleeding episodes (p = 0.035).

Regarding bleeding incidents, 44% (dual therapy) vs. 51.1% (monotherapy) occurred on the day of surgery. The bleeding risk after dental extractions is overall low and patients were often hospitalized preventively due to their comorbidities rather than actual bleeding risk. Patients should be instructed about local compression, and surgeries should be completed in the morning to avoid emergency visits. However, patients with cardiovascular diseases and dual therapy had a higher risk of postoperative haemorrhage. Thus, hospitalization is to be considered in these cases.

Reference:

Katz, M.S., Benidamou, R., Ooms, M. et al. Influence of antiplatelet medication and anticoagulation therapy after dental extractions on hospitalization: a retrospective 10-year study. BMC Oral Health 24, 1485 (2024). https://doi.org/10.1186/s12903-024-05275-6