title: Pragmatic approach to manage new oral anticoagulants in patients undergoing dental extractions: a prospective case-control study.
abstract: OBJECTIVE
  The aim of this study was to validate a standardized pragmatic approach to manage new oral anticoagulants (NOACs) in patients who undergo dental extractions.
  
  
  METHODS
  This prospective case-control study in patients undergoing dental extraction included 26 patients (mean age 76 years, 57% male) treated with dabigatran, rivaroxaban, or apixaban and 26 matched controls. Regardless of timing of extraction, drug regimen, or renal function, patients were instructed to skip only the dose on the morning of the procedure. A procedural bleeding score was recorded and early and delayed bleeding was assessed at day 1 and day 7. Bleeding events were compared with a prospectively matched control group not taking any antithrombotic drug.
  
  
  RESULTS
  There was no difference in the procedural bleeding score or in early bleeding events (5 in both groups). However, delayed bleeding occurred more frequently in anticoagulated compared to non-anticoagulated patients (7 versus none, p = 0.01).
  
  
  CONCLUSIONS
  Skipping the morning dose of NOACs avoids excess bleeding during and early after the procedure. However, anticoagulated patients had an increased risk of delayed bleedings. Further study is needed to determine the optimal post-procedural management.
  
  
  CONCLUSIONS
  This is the first prospective study for the management of patients on NOACs undergoing dental extraction. Our pragmatic approach, omitting only a single morning dose, can guide clinical practice. Both patients and physicians should be aware of the increased delayed bleeding risk.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. isabel.miclotte@uzleuven.be.
authors.forename: Isabel
authors.identifier: http://orcid.org/0000-0002-9126-2123
authors.initials: I
authors.lastname: Miclotte
authors.affiliation: Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
authors.forename: Maarten
authors.initials: M
authors.lastname: Vanhaverbeke
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
authors.forename: Jimoh Olubanwo
authors.initials: JO
authors.lastname: Agbaje
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Legrand
authors.affiliation: Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vanassche
authors.affiliation: Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Verhamme
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
authors.forename: Constantinus
authors.initials: C
authors.lastname: Politis
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D016022:Case-Control Studies; D017742:Dental Care for Chronically Ill; D005260:Female; D006801:Humans; D008297:Male; D006472:Oral Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D014081:Tooth Extraction
chemical_list: D000925:Anticoagulants
keywords: Anticoagulants; Bleeding; Interruption; New oral anticoagulants (NOACs); Tooth extraction