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The continuation of oral anticoagulation and antiplatelet therapy for dento-alveolar surgery: a service evaluation

British Dental Journal volume 235, pages 313–318 (2023)Cite this article

Abstract

Background Patients taking oral anticoagulants (OACs) and oral antiplatelets (OAPs) have a risk of post-operative bleeding when dental extractions are required. Guidance exists to assist dental practitioners on how best to clinically manage these patients, but this is based upon low-quality evidence. The current service evaluation provides real world clinical data when these drugs are not discontinued for oral surgery procedures.

Materials and methods All OACs and OAPs were continued and patients requiring dental extractions had local haemostatic measures (local anaesthesia with adrenaline, socket packing with haemostat and resorbable sutures). All patients were offered a follow-up via a telephone clinic service after surgery to assess any post-operative bleeding.

Results A total of 439 patients underwent 513 surgical episodes, equating to 1,001 dental extractions. Overall, 412 (95.9%) patients reported no post-operative bleeding complications. A total of 18 (4.1%) patients reported post-operative bleeding requiring further intervention. All but two patients were managed with local haemostatic measures, and no patient required hospital admission. For the single novel OAC cohort of patients, 8/185 (4.3%) procedures had post-operative bleeding.

Conclusion This current service evaluation highlights that the risk of significant or life-threatening bleeding following dental extraction when OACs or OAPs are continued remains rare.

Key points

  • Highlights the low risk of significant or life-threatening bleeding following dental extractions in patients on oral anticoagulants or antiplatelets.

  • There was a higher percentage of post-operative bleeding from patients taking warfarin than those on direct oral anticoagulants.

  • Provides much-needed evidence on this subject, which is currently dictated by guidance acknowledging limited evidence.

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Acknowledgements

The authors would like to thank all clinical staff members in the oral surgery department at our hospital who kindly contributed towards this service evaluation.

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Authors and Affiliations

  1. Speciality Registrar, Oral Surgery, Oral and Maxillofacial Surgery Department, Salisbury District Hospital, United Kingdom

    Pradeep Sandhu

  2. Speciality Dentist, Oral Surgery, Oral Surgery Department, Guy´s and St Thomas´ Hospital, United Kingdom

    Serena Mayor

  3. Consultant, Oral Surgery, Oral Surgery Department, Guy´s and St Thomas´ Hospital, United Kingdom

    Christopher Sproat, Jerry Kwok, Kiran Beneng & Vinod Patel

Authors
  1. Pradeep Sandhu
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  2. Serena Mayor
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  3. Christopher Sproat
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  4. Jerry Kwok
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  5. Kiran Beneng
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  6. Vinod Patel
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Contributions

Conceptualisation (Vinod Patel, Christopher Sproat, Jerry Kwok, Kiran Beneng), data curation (Pradeep Sandhu, Serena Mayor), data analysis (Pradeep Sandhu), manuscript preparation (Pradeep Sandhu, Vinod Patel), manuscript review (Pradeep Sandhu, Vinod Patel, Christopher Sproat, Jerry Kwok, Kiran Beneng).

Corresponding author

Correspondence to Vinod Patel.

Ethics declarations

The authors declare no conflicts of interest.

Ethical approval was not applicable as this is a clinical service evaluation of current longstanding practice and not a research study. The service evaluation utilised psuedonymised data collection via dental records.

Data availability: not applicable.

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Sandhu, P., Mayor, S., Sproat, C. et al. The continuation of oral anticoagulation and antiplatelet therapy for dento-alveolar surgery: a service evaluation. Br Dent J 235, 313–318 (2023). https://doi.org/10.1038/s41415-023-6227-5

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  • DOI: https://doi.org/10.1038/s41415-023-6227-5

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