title: Management of dental extraction in patients undergoing anticoagulant oral direct treatment: a pilot study.
abstract: OBJECTIVE
  The main goal of this study was to compare the incidence of postoperative bleeding events after dental extractions between patients treated with direct oral anticoagulants (DOACs) and those treated with vitamin K antagonists (VKAs) without withdrawal of oral anticoagulant therapy (OAT). Our second objective was to evaluate the risk factors affecting postoperative hemorrhage after tooth extraction in patients taking DOACs.
  
  
  METHODS
  This prospective observational study included 51 patients who were being treated with oral anticoagulants and required dental extractions. They were divided into two groups: 31 patients receiving a DOAC and 20 control patients taking VKA with an international normalized ratio between 2.0 and 3.0. In both groups, extractions were performed under continued OAT, and the same local hemostatic measures were applied. All procedures were performed in an outpatient facility. A bleeding event was defined as persistent oozing or marked hemorrhage over 20 minutes after tooth extraction despite local hemostasis procedures or all bleeding episode occurring during the first postoperative week.
  
  
  RESULTS
  Five patients taking DOACs had seven bleeding episodes, and four patients receiving VKAs had five bleeding episodes during the postoperative follow-up period. The difference in the number of bleeding events between the two groups was not statistically significant (adjusted odds ratio = 0.77; 95% confidence interval 0.19-3.19; P = .723). Eleven (91.67%) bleeding events were mild and controlled by mechanical compression with gauzes, and one (8.33 %) was managed with a revision of the wound, application of fibrin glue, and resuturing. No bleeding required hospitalization or blood transfusion. All bleeding episodes occurred during the first 3 postoperative days.
  
  
  CONCLUSIONS
  According to our preliminary outcome data, dental extractions can be performed safely in an outpatient facility in patients treated with DOAC by applying local hemostatic measures, without interrupting or modifying OAT.
authors.affiliation: AP-HP, Service d'Odontologie, Groupe Hospitalier Pitié Salpêtrière Charles Foix, Paris, France; Service d'Odontologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire, Reims, France; Laboratoire E.A., 4691 Biomateriaux et Inflammation en Site Osseux, Université Reims Champagne-Ardennes, Reims, France. Electronic address: Mauprivez.cedric@gmail.com.
authors.forename: Cédric
authors.initials: C
authors.lastname: Mauprivez
authors.affiliation: AP-HP, Service de chirurgie maxillo-faciale, Paris, France; UPMC Université Paris 06, Paris, France.
authors.forename: Roman Hossein
authors.initials: RH
authors.lastname: Khonsari
authors.affiliation: AP-HP, Service de chirurgie maxillo-faciale, Paris, France; UPMC Université Paris 06, Paris, France.
authors.forename: Omar
authors.initials: O
authors.lastname: Razouk
authors.affiliation: AP-HP, Service de chirurgie maxillo-faciale, Paris, France; UPMC Université Paris 06, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goudot
authors.affiliation: Consultant, INSERM 791, LIOAD; Université de Nantes, UMRS-S 791, LIOAD, UFR d'Odontologie; ONIRIS, UMR-S 791, LIOAD; CHU Nantes, PHU 4 OTONN, Nantes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lesclous
authors.affiliation: AP-HP, Service d'Odontologie, Groupe Hospitalier Pitié Salpêtrière Charles Foix, Paris, France.
authors.forename: Vianney
authors.initials: V
authors.lastname: Descroix
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D014081:Tooth Extraction
chemical_list: D000925:Anticoagulants