Four-year cross-sectional study of bleeding risk in dental patients on direct oral anticoagulants

Objective: New oral anticoagulants, or "direct oral anticoagulants" (DOACs), have been used worldwide in recent years. An evidence-based enigma regarding dental patients using DOACs still exists. Method and Materials: This was a 4-year, cross-sectional study on individuals receiving DOAC therapy, treated in a single maxillofacial center. A bleeding event was the outcome parameter. Potential contributing risk factors were evaluated. Results: Of a total of 111 patients, 72 underwent a total of 305 oral procedures in 115 sessions. The overall frequency of bleeding events was 6.1% per session. One "major" (0.9%) and six "minor" (5.2%) events were recorded. The management was simple, local hemostasis. Statistically significant association was found between bleeding events and (1) history of spontaneous hemorrhage and (2) surgical procedures involving soft tissue manipulation. Withdrawal of DOAC therapy was not associated with decreased postoperative bleeding events. Conclusion: The risk of bleeding in dental patients using DOACs is low with no major consequences. The data support not stopping DOACs prior to dental treatment, regardless of the complexity or the extent of the procedure. Dosage adaptation is recommended in patients with a history of spontaneous hemorrhage. Keywords: anticoagulants, bleeding, oral surgery