Dental surgical procedures in patients using oral anticoagulants: an integrative literature review
Procedimentos cirúrgicos odontológicos em pacientes em uso de anticoagulantes orais diretos: uma revisão de literatura integrativa
Resumo
The objective of this review was to evaluate the impact of oral anticoagulants (DOACS) on dental surgical procedures and offer suggestions for conduct for adequate and safe surgical-dental treatment. The bibliographic research was carried out in three databases: PubMed, Scopus, Embase, in addition to manual searches and gray literature, limited to the years 2018 to 2024 and the English and Portuguese languages. The search strategies used were: "Anticoagulants" AND "Oral Surgical Procedures" and Factor Xa Inhibitors". 193 articles were identified, but seven studies were included in this integrative review. All articles demonstrate that low-risk bleeding procedures have good clinical results without interrupting DOACs. Most articles recommend additional local hemostatic measures and adjustments in the dosing time of DOACs. avoid surgery during peak blood concentration. Therefore, the data from this study suggest that in most cases it is not necessary to stop new oral anticoagulants in bloody dental procedures.
Downloads
Referências
Andrade MVS, Andrade LAP, Bispo AF, et al. Evaluation of the Bleeding Intensity of Patients Anticoagulated with Warfarin or Dabigatran Undergoing Dental Procedures. Arq Bras Cardiol. 2018;111(3):394-399. doi:10.5935/abc.20180137
Brennan Y, Gu Y, Schifter M, Crowther H, Favaloro EJ, Curnow J. Dental extractions on direct oral anticoagulants vs. warfarin: The DENTST study. Res Pract Thromb Haemost. 2020;4(2):278-284. doi:10.1002/rth2.12307
Buchbender M, Schlee N, Kesting MR, Grimm J, Fehlhofer J, Rau A. A prospective comparative study to assess the risk of postoperative bleeding after dental surgery while on medication with direct oral anticoagulants, antiplatelet agents, or vitamin K antagonists. BMC Oral Health. 2021;21(1):504. Published 2021 Oct 7. doi:10.1186/s12903-021-01868-7
Chan MH, Sun F, Malakan J. Controversies in Stoppage of Antiplatelet and Anticoagulant Medications Prior to Oral Surgery. Dent Clin North Am. 2024;68(1):21-45. doi:10.1016/j.cden.2023.07.001
Elad S, Marshall J, Meyerowitz C, Connolly G. Novel anticoagulants: general overview and practical considerations for dental practitioners. Oral Dis. 2016;22(1):23-32. doi:10.1111/odi.12371
Grillo, T. A.; Miranda, R. D. C. Os novos anticoagulantes orais na prática clínica. Revista Médica de Minas Gerais, 24(Supl 8): S87-S95. doi: 10.5935/2238-3182.20140132
Higashi EM, Itagiba Neves IL, da Costa Darrieux FC, dos Santos Paul MA, Alkmin Paiva GL, et al. Direct Oral Anticoagulants in the Scenario of Oral Surgery: Safety Aspects in a Single Center Experience. Int J Clin Cardiol Res. 2020;4(1): 009-011.
Hong, C. H.; Islam, I. Anti-thrombotic therapy: implications for invasive outpatient procedures in dentistry. Journal of Blood Disorders & Transfusion, 2013; 4(6) 1-7. doi: DOI: 10.4172/2155-9864.1000166
J. Lee. OR364 - Oral surgery in patients taking oral vitamin K antagonists and non-vitamin K antagonist oral anticoagulants. International Journal of Oral and Maxillofacial Surgery, 2024; 52(2)135. doi: https://doi.org/10.1016/j.ijom.2023.10.375.
Jun M, Lix LM, Durand M, et al. Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study. BMJ. 2017;359:j4323. doi:10.1136/bmj.j4323
Lababidi E, Breik O, Savage J, Engelbrecht H, Kumar R, Crossley CW. Assessing an oral surgery specific protocol for patients on direct oral anticoagulants: a retrospective controlled cohort study. Int J Oral Maxillofac Surg. 2018;47(7):940-946. doi:10.1016/j.ijom.2018.03.009
Menezes, L. dos S.; Oliveira, R. S. B.; Silva, L. C. F. Avaliação do nível de conhecimento de cirurgiões-dentistas e graduandos em Odontologia quanto ao manejo de indivíduos em uso de anticoagulantes orais. Revista de Odontologia da UNESP, 2018;47(5):321-327. doi: https://doi.org/10.1590/1807-2577.09718
Paraschiv, C. et al. Dental implications of the new oral anticoagulants. Romanian Journal of Oral Rehabilitation, 2015;7(4):30-36.
Quintero Parada, E. et al. Hemostasia y tratamiento odontológico. Avances en Odontoestomatología, 20014;20(5): 247-261. doi: ibc-36173
Ruff CT, Braunwald E. Will warfarin ever be replaced?. J Cardiovasc Pharmacol Ther. 2010;15(3):210-219. doi:10.1177/1074248410366448
Senoo K, Kondo Y, Miyazawa K, Isogai T, Chun YH, Kobayashi Y. Safety and efficacy of direct oral anticoagulants over warfarin in Japanese patients with acute venous thromboembolism: A meta-analysis. J Cardiol. 2017;69(5):763-768. doi:10.1016/j.jjcc.2016.07.007
Tomaselli GF, Mahaffey KW, Cuker A, et al. 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Solution Set Oversight Committee [published correction appears in J Am Coll Cardiol. 2021 Jun 1;77(21):2760]. J Am Coll Cardiol. 2020;76(5):594-622. doi:10.1016/j.jacc.2020.04.053
Yoshikawa H, Yoshida M, Yasaka M, et al. Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study. Int J Oral Maxillofac Surg. 2019;48(8):1102-1108. doi:10.1016/j.ijom.2019.01.013
