Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational survey

Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational survey

Background: Oral surgery is a frequent invasive procedure in patients on oral anticoagulants. In usual care, the periprocedural management of these patients is questioned, with conflicting guidelines for patients on direct oral anticoagulants (DOACs). Objectives: To assess the risk of hemorrhagic an...

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Main Authors: Isabelle Mahé, David Hajage, Virginie Monnet–Corti, Louis Maman, Vianney Descroix, Yann De Rycke, Loredana Radoï, Thong Nguyen, Roch Pecorari, Adeline Loing, Jonathan Ravasco, Tanguy Rouxel, Marion Renoux, Ejeil Anne-Laure, Nathan MOREAU, Marjolaine Gosset, Nicolas Roche, Ihsène Taïhi-Nassif, Nadia Benlagha, Juliette Rochefort, Rafael Toledo Arenas, Géraldine Lescaille, Marc Baranes, Anne-Cécile Becmeur, Sylvie Boisramé, Romain Lan, Jean-Hugues Catherine, Ugo Ordioni, Fabrice Campana, Anne-Gaëlle Chaux, Sylvian Catros, Jean-Marie Marteau, Johan Samot, Mathilde Fenélon, Julie Guillet, Charlene Kichenbrand, Bérengère Phulpin, Nicolas Glock, Cécile Chatel, Michel Guyot, François Allain, Julie Bemer, Alp Alantar, Catherine Pesci-Bardon, Oulimata Diatta-Tricon, Tariq Kabli, Moulay Chemlal
Format: Article
Language:English
Published: Elsevier 2025-03-01
Series:Research and Practice in Thrombosis and Haemostasis
Subjects:
anticoagulant
atrial fibrillation
bleeding
oral surgery
venous thromboembolism
Online Access:http://www.sciencedirect.com/science/article/pii/S2475037925001724
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Summary:Background: Oral surgery is a frequent invasive procedure in patients on oral anticoagulants. In usual care, the periprocedural management of these patients is questioned, with conflicting guidelines for patients on direct oral anticoagulants (DOACs). Objectives: To assess the risk of hemorrhagic and thromboembolic events during the periprocedural period (5 days before and 30 days after the oral invasive procedure). Methods: The PRatiques Anticoagulants oraux DIrects Chirurgie Orale Study (NCT 03150303) is a prospective noninterventional national study including patients receiving long-term oral anticoagulants (duration of treatment of at least 1 month) and referred to dental surgeons for an invasive procedure. Hemorrhagic and thromboembolic events and death on days 2, 7, and 30 were reported and analyzed according to anticoagulant management (interruption/continuation). Bleedings were classified according to the International Society on Thrombosis and Haemostasis classification after blinded review. Results: Overall, between July 2017 and December 2019, 523 patients (mean age 74) were recruited (345 on DOACs and 178 on vitamin K antagonists [VKAs]). During the periprocedural period, 62 events (11.8 events per 100 person-month [PM]) occurred, all local bleedings, in 50 patients (90.3% during the 7 days). The incidence of postoperative bleeding was greater in patients who continued on DOACs compared with patients who continued on VKAs (15.9/100 PM vs 5.9/100 PM; P = .003). Conversely, no significant difference was observed between patients with DOAC discontinuation and patients with VKA continuation (6.2/100 PM vs 5.9/100 PM; P = .75). Conclusion: In patients on anticoagulants undergoing an invasive oral procedure, the risk of bleeding occurs mainly within the 7 days following the procedure. Our data suggest the benefit of short perioperative discontinuation of DOACs.
ISSN:2475-0379

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