Postoperative bleeding risk for oral surgery under continued rivaroxaban anticoagulant therapy.
OBJECTIVE
The purpose of this study was to assess the risk of postoperative bleeding complications after oral procedures performed under continued mono or dual anticoagulation therapy with rivaroxaban (and aspirin).


METHODS
This retrospective single-center observational study included 52 oral procedures performed under continued oral anticoagulant therapy with rivaroxaban (20 mg/day). Among them, two procedures were performed under continued dual therapy with aspirin (100 mg/day) added to the regimen. Postoperative bleeding events were compared with 285 oral procedures in patients without any anticoagulation/antiplatelet therapy.


RESULTS
Postoperative bleeding complications after oral surgery occurred significantly more often in patients under continued rivaroxaban therapy (11.5 %) than in the control cases without anticoagulation/antiplatelet medication (0.7 %). All of the bleeding events were manageable: Two of them were treated with local compression, three by applying new fibrin glue with (one case) or without (two cases) secondary sutures, one occurred during a weekend and was therefore treated under inpatient conditions with suture replacement. All postoperative bleeding episodes occurred during the first postoperative week.


CONCLUSIONS
According to our data, continued anticoagulation therapy with rivaroxaban significantly increases postoperative bleeding risk for oral surgical procedures, although the bleeding events were manageable.


CONCLUSIONS
Oral surgeons, cardiologists, general physicians, and patients should be aware of the increased bleeding risk after oral surgical procedures. Close observation up to 1 week postoperatively is advisable to prevent excessive bleeding.
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 52 Martinistrasse, Hamburg, 20246, Germany.
Henning
H
Hanken
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 52 Martinistrasse, Hamburg, 20246, Germany.
Alexander
A
Gröbe
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 52 Martinistrasse, Hamburg, 20246, Germany.
Max
M
Heiland
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 52 Martinistrasse, Hamburg, 20246, Germany.
Ralf
R
Smeets
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 52 Martinistrasse, Hamburg, 20246, Germany.
Lan
L
Kluwe
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 52 Martinistrasse, Hamburg, 20246, Germany.
Johannes
J
Wikner
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 52 Martinistrasse, Hamburg, 20246, Germany.
Robert
R
Koehnke
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 52 Martinistrasse, Hamburg, 20246, Germany.
Ahmed
A
Al-Dam
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 52 Martinistrasse, Hamburg, 20246, Germany. w.eichhorn@uke.de.|Department of Oral and Maxillofacial Surgery, General Hospital Balingen, 30 Tuebinger Strasse, Balingen, 72336, Germany. w.eichhorn@uke.de.
Wolfgang
W
Eichhorn
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D065427:Factor Xa Inhibitors / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D019647:Oral Surgical Procedures; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D000069552:Rivaroxaban / Q000008:administration & dosage*
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban; D001241:Aspirin
Bleeding; Direct oral anticoagulants (DOAC); Oral anticoagulants; Oral osteotomy; Rivaroxaban