title: Management of anticoagulated patients in implant therapy: a clinical comparative study.
abstract: OBJECTIVE
  This prospective clinical comparative study aimed to analyze the postoperative bleeding risk of patients continuing their anticoagulation therapy (AT) and undergoing implant surgery and bone grafting procedures.
  
  
  METHODS
  The treatments ranged from the insertion of single or multiple dental implants over implant exposures to sinus floor augmentation and vertical and/or lateral bone grafting with autologous bone grafts. The patients of the test groups (AT groups) were treated with platelet aggregation inhibitors (PAIs), Vitamin-K inhibitors, Vitamin-K inhibitor withdrawal bridged with heparin (LMWH), or new/direct oral anticoagulants (NOACs/DOACs). Patients of the control group were non-anticoagulated (non-AT group). Surgical procedures were performed in the same manner in all groups. Pre, intra, and postoperative data concerning the treatment, extent of the surgery and bleedings was recorded and statistically evaluated.
  
  
  RESULTS
  There were seven postoperative bleedings in 564 patients (1.2%), four in the AT groups (3.4%), and three in the non-AT group (0.6%). No thromboembolic complication occurred in the whole observation period. The invasiveness of the surgical procedure had no statistically significant effect on bleeding frequencies. Patients taking Vitamin-K inhibitors had a significantly higher risk of a postoperative bleeding compared to patients without any AT (P = 0.038). Two patients were hospitalized due to the severity of the bleeding as a precautionary measure (one in the non-AT and one in the PAI group). All bleedings were easily controllable with local hemostatic measures. There was no postoperative bleeding recorded for patients taking DOACs.
  
  
  CONCLUSIONS
  Anticoagulation therapy should be continued in patients undergoing implant surgery and bone grafting procedures avoiding thromboembolic complications. Surgeons should always apply the most minimally invasive approach to reduce postoperative risks and be able to apply local hemostatic measures in terms of a bleeding complication.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Clemm
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: F W
authors.initials: FW
authors.lastname: Neukam
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Rusche
authors.affiliation: Private Practice Prof. Schlegel and Colleagues, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Bauersachs
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Musazada
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany. Christian.Schmitt@uk-erlangen.de.
authors.forename: C M
authors.initials: CM
authors.lastname: Schmitt
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D016025:Bone Transplantation / Q000009:adverse effects*; D003757:Dental Implantation / Q000009:adverse effects*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D011446:Prospective Studies; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K
keywords: DOAC, anticoagulation therapy; augmentation; bridging; dental implant; new oral anticoagulants; oral anticoagulation; oral surgery; phenprocoumon; warfarin