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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Elsevier
2025-03-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475037925001724 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Isabelle Mahé |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-5d9458a0d2554231b51fa0e349a09dbe |
| institution | Kabale University |
| issn | 2475-0379 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj-art-5d9458a0d2554231b51fa0e349a09dbe2025-08-20T03:25:05ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792025-03-019310284810.1016/j.rpth.2025.102848Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational surveyIsabelle Mahé0David Hajage1Virginie Monnet–Corti2Louis Maman3Vianney Descroix4Yann De Rycke5Loredana Radoï6Thong NguyenRoch PecorariAdeline LoingJonathan RavascoTanguy RouxelMarion RenouxEjeil Anne-LaureNathan MOREAUMarjolaine GossetNicolas RocheIhsène Taïhi-NassifNadia BenlaghaJuliette RochefortRafael Toledo ArenasGéraldine LescailleMarc BaranesAnne-Cécile BecmeurSylvie BoisraméRomain LanJean-Hugues CatherineUgo OrdioniFabrice CampanaAnne-Gaëlle ChauxSylvian CatrosJean-Marie MarteauJohan SamotMathilde FenélonJulie GuilletCharlene KichenbrandBérengère PhulpinNicolas GlockCécile ChatelMichel GuyotFrançois AllainJulie BemerAlp AlantarCatherine Pesci-BardonOulimata Diatta-TriconTariq KabliMoulay ChemlalParis Cité University, AP-HP, Hôpital Louis Mourier, Service de Médecine Interne, Colombes, France; Team Endotheliopathy and Hemostasis Disorders, INSERM UMR-S970, Paris Cardiovascular Research Center, Paris, France; Correspondence Isabelle Mahé, Hôpital Louis Mourier, AP-HP, Service de Médecine Interne, 178 rue des Renouillers, 92700 Colombes, France.Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France; Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, AP-HP, Hôpital Pitié Salpêtrière, Paris, FranceFaculté des Sciences Médicales et Paramédicales, École de Médecine Dentaire, Aix-Marseille Univ, Marseille, France; AP-HM, Hôpital Timone, Pôle Odontologie, UF de Parodontologie, Marseille, France; MEPHI, IRD, AP-HM, IHU Méditerranée Infection, Aix-Marseille Univ, Marseille, France; on behalf of the Société Française de Parodontologie et d’ImplantologieUniversité Paris Cité, UFR d’Odontologie, Hôpital Charles Foix, Paris, France; on behalf of the Société Française de Chirurgie OraleService Médecine Bucco–Dentaire, Institut de chirurgie dentaire–Hôpital Pitié Salpêtrière, AP-HP, LabNOF (Laboratoire de Neurobiologie OroFaciale, EA7543), Paris, FranceSorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France; Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, AP-HP, Hôpital Pitié Salpêtrière, Paris, FranceUniversité Paris Cité, UFR d’Odontologie, AP-HP, Hôpital Louis Mourier, Colombes, France; Université Paris-Saclay, UVSQ, INSERM U1018, Gustave Roussy, CESP, Villejuif, FranceBackground: 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.http://www.sciencedirect.com/science/article/pii/S2475037925001724anticoagulantatrial fibrillationbleedingoral surgeryvenous thromboembolism |
| spellingShingle | 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 Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational survey Research and Practice in Thrombosis and Haemostasis anticoagulant atrial fibrillation bleeding oral surgery venous thromboembolism |
| title | Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational survey |
| title_full | Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational survey |
| title_fullStr | Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational survey |
| title_full_unstemmed | Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational survey |
| title_short | Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational survey |
| title_sort | oral anticoagulant periprocedural management in patients undergoing an oral dental implant or periodontal surgery a prospective national observational survey |
| topic | anticoagulant atrial fibrillation bleeding oral surgery venous thromboembolism |
| url | http://www.sciencedirect.com/science/article/pii/S2475037925001724 |
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