Postoperative Bleeding After Dental Extraction Among Elderly Patients Under Anticoagulant Therapy

 

TAKE-HOME MESSAGE

  • This retrospective study aimed to compare post-extraction bleeding incidence in medically compromised elderly (≥65 years) individuals. A total of 232 patients undergoing anticoagulant therapy and who underwent single or multiple extractions were included, with extraction sites being managed by local hemostatic measures (pressure, Surgicel, and suturing) immediately postop. Incidence of postoperative bleeding (1–7 days) was highest in patients taking rivaroxaban (32.4%), followed by apixaban (18.2%), warfarin (17.3%), and edoxaban (5.7%), while patients taking dabigatran did not present with postoperative bleeding, with the difference between rivaroxaban versus apixaban and edoxaban being statistically significant.

  • Direct oral anticoagulants (DOACs; eg, rivaroxaban, apixaban, edoxaban, dabigatran) are gaining popularity over vitamin K antagonists (eg, warfarin) for anticoagulant therapy due to convenient dosing, fewer interactions with food, shorter half-life, and not requiring monitoring. The findings of this study, which reveal a difference in the incidence of postoperative bleeding associated with different DOACs, are important, especially as we care for a growing geriatric population.
– Tapan N. Koticha, BDS, MDS

OBJECTIVES

This study aimed to assess and compare postoperative bleeding occurrence after dental extraction in medically compromised elderly patients under anticoagulant therapy.

MATERIALS AND METHODS

This retrospective study included medically compromised elderly patients aged ≥ 65 years who were taking apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin and had undergone single or multiple dental extractions. The primary outcome measure was postoperative bleeding occurrence, which was defined as oozing or marked hemorrhage from 24 h to 7 days after dental extraction. Postoperative bleeding occurrence was calculated for each anticoagulant and compared using Fisher's exact test, followed by multiple comparisons.

RESULTS

Two hundred thirty-two patients met the inclusion criteria. The highest postoperative bleeding occurrence was recorded for rivaroxaban (12/37: 32.4%), followed by apixaban (8/44: 18.2%), warfarin (17/98: 17.3%), and edoxaban (2/35: 5.7%). Patients taking dabigatran did not present postoperative bleeding (0/18: 0%). Fisher's exact test, followed by multiple comparison tests, revealed a significant among-anticoagulant difference (p = 0.0095). Postoperative bleeding was significantly higher in patients taking rivaroxaban than in those taking edoxaban or dabigatran (p = 0.03088).

CONCLUSIONS

Within the limitations of this retrospective study design, these findings suggest that different anticoagulants may affect postoperative bleeding occurrence after dental extraction among medically compromised elderly patients.

CLINICAL RELEVANCE

Clinicians should carefully consider postoperative bleeding after dental extraction in patients taking anticoagulant therapy, especially rivaroxaban.

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