title: Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies.
abstract: Background and Objective:Minor dental surgery is invasive and hemorrhagic. Thus, in patients treated with anticoagulants, the bleeding risk related to these invasive procedures is concerning. The aim of this meta-analysis is to evaluate this risk by comparing the post-operative bleeding rates of oral anticoagulation treatment (OAT) patients (without interrupted or altered anticoagulant intake) with non-OAT patients.Methods:PubMed, Embase and the Cochrane Library were searched for eligible studies that compared the post-operative (following minor dental surgery) bleeding rates of OAT patients without interrupted or altered therapy with those of non-OAT patients. Relative risk (RR) and 95% confidence interval (CI) were calculated. Subgroup analyses were used to identify the association between the bleeding rate and different dental surgeries or anticoagulants.Results:Thirty two full text articles were assessed for eligibility and 20 studies were excluded according to the selection criteria. Finally, 12 studies and a total of 2102 OAT patients and 2271 non-OAT patients were included. A pooled analysis indicated that the post-operative bleeding risk in OAT patients is higher than that of non-OAT patients (RR: 2.794, 95% CI: 1.722-4.532,P= 0.000). The pooled RRs in the dental implant surgery and dental extraction subgroups were 2.136 (95% CI: 0.825-5.531,P= 0.118) and 2.003 (95% CI: 0.987-4.063,P= 0.054), respectively. As for the different oral anticoagulants, the pooled RR in the subgroup of new oral anticoagulants (NOACs) was 1.603 (95% CI: 0.430-5.980,P= 0.482), while the pooled RR in the vitamin K antagonists subgroup was 3.067 (95% CI: 1.838-5.118,P= 0.000).Conclusion:Under current evidence, OAT patients were under a higher post-operative bleeding risk than the non-OAT patients following minor dental surgery. For the dental implant surgeries and dental extractions, our study failed to demonstrate a higher risk of bleeding in the OAT patients compared with the non-OAT patients. Besides, The NOACs might be safer than the vitamin K antagonists in dental implant surgery. However, more well-designed studies are required for future research.
authors.affiliation: Institute of Stomatology, Chinese PLA General Hospital Beijing, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Institute of Stomatology, Chinese PLA General Hospital Beijing, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Xu
authors.affiliation: Institute of Stomatology, Chinese PLA General Hospital Beijing, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Institute of Stomatology, Chinese PLA General Hospital Beijing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Institute of Stomatology, Chinese PLA General Hospital Beijing, China.
authors.forename: Hongchen
authors.initials: H
authors.lastname: Liu
keywords: dental surgery; meta-analysis; oral anticoagulants; patients; post-operative hemorrhage; relative risk