Real-World EVIDENCE
Ono et al (2022)7 conducted a retrospective study that compared the risk of postextraction bleeding in patients on warfarin (n=1557) or DOACs (n=3696) from the DeSC database (large-scale administrative claims database in Japan) between April 2015 to November 2020. The postextraction bleeding was assessed 7 days after the extraction. In the weighted population (n=517.7 for both groups), the incidence of postextraction bleeding was 1.9% vs 2.2% (OR, 0.86; 95% confidence interval [CI], 0.47-1.57) or revisit was 1.3% vs 1.5% (OR, 0.91; 95% CI, 0.43-1.95) and there was no difference between XARELTO and warfarin, respectively.
Lababidi et al (2018)8conducted a retrospective, controlled, cohort study to evaluate a noncessation protocol for patients taking (DOACs; XARELTO, n=26; apixaban, n=14; and dabigatran, n=3) compared to warfarin during dental extractions. Patients on DOAC therapy (n=43 underwent 53 dentoalveolar procedures) were compared to patients on uninterrupted warfarin therapy (n=50 underwent 59 dentoalveolar procedures). Under physician advice, 15 of the 53 dentoalveolar procedures were performed following perioperative cessation of a DOAC. Minor bleeding events were recorded in the warfarin (n=9) and noncessation DOAC group (n=4), 15.3% and 10.5%, respectively, showing no statistically significant difference (OR, 0.65; P=0.56). Patients in the DOAC session group recorded no bleeding events.
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Cocero et al (2019)9 conducted a retrospective cohort study of patients (N=100) undergoing tooth extractions while continuing DOACs (dabigatran, n=39; apixaban, n=37; XARELTO, n=24). Incidence of excessive bleeding occurring from a few hours up to 7 days following extractions was the primary endpoint. There was no bleeding in the patient population without comorbidities (0%; 95% CI: 0-8%). In patients with comorbidities, 4 bleeding cases were identified (6.25%; 95% CI: 2.5-15%; P=0.29); 3 cases were mild (2 with apixaban and 1 with XARELTO) and 1 was moderate (XARELTO). Extractions of couples and triples of multirooted teeth (P=0.004) significantly triggered bleeding in patients with comorbidities.
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Miller et al (2018)10conducted a retrospective cohort study of 12 patients on DOACs (XARELTO, n=7; apixaban, n=2; dabigatran, n=2; and edoxaban, n=1) undergoing 17 oral surgical procedures. In 52.9% of the cases (n=9), the DOAC was discontinued, vs 5.8% (n=1) and 41.2% (n=7) of cases in which the DOAC was continued or not recorded, respectively. There were no reports of bleeding complications for any of the patients.
Ueda et al (2023)11conducted aretrospective study investigating factors affecting bleeding after dental extraction in 395 patients (aged ≥65 years) receiving anticoagulants, including apixaban (n=74), edoxaban (n=66), XARELTO (n=65), and warfarin (n=190). Overall, 75 patients experienced postoperative bleeding, with the incidence being 27.7% with XARELTO, 21.6% with apixaban, 18.4% with warfarin, and 9.1% with edoxaban. None of these patients required blood transfusion or hospitalization.
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