Oral surgery, oral medicine, oral pathology and oral radiology · 2025
Proposal for a tooth extraction protocol for patients taking direct oral anticoagulants: a clinical trial.
СтатьяНазвание и аннотация: Перевод в очереди
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Higashi Elaine Massumi, Neves Itamara Lucia Itagiba, Darrieux Francisco Carlos da Costa, Alves Dos Santos Paul Marcela, Paiva Gustavo Luiz Alkmin, Omori Vitor Takao, Simões Neves Ricardo, Scanavacca Maurício Ibraim, Hachul Denise Tessariol
Аннотация
OBJECTIVE: To evaluate the feasibility of a protocol in which direct oral anticoagulants (DOACs) are not discontinued prior to tooth extractions, compared with warfarin.
STUDY DESIGN: A prospective blind study was conducted on anticoagulated patients with atrial fibrillation undergoing tooth extraction. Patients were divided into three groups according to the anticoagulant pharmacokinetics: 20 patients on rivaroxaban once daily; 18 on dabigatran or apixaban twice daily, and 20 on warfarin (control group). Extractions were scheduled during the lowest DOACs plasma concentration: 14 hours after the last rivaroxaban dose; 8 hours after the last dabigatran/apixaban dose; and with INR values between 2.0 and 3.0 in the warfarin group. Patients returned 24 hours after tooth extraction for evaluation of bleeding.
RESULTS: Fifty-eight patients were included in the study, in a total of 84 tooth extractions. No minor or major bleeding occurred in the rivaroxaban group. Two patients in the dabigatran/apixaban group (11.1%) and two in the control group (10%) presented minor bleeding. There was no statistically significant difference in bleeding rates among the groups (P = .324), and no major bleeding events were reported.
CONCLUSION: These preliminary results suggest that the protocol proposing non-discontinuing DOACs in extractions may be feasible in clinical practice.
STUDY DESIGN: A prospective blind study was conducted on anticoagulated patients with atrial fibrillation undergoing tooth extraction. Patients were divided into three groups according to the anticoagulant pharmacokinetics: 20 patients on rivaroxaban once daily; 18 on dabigatran or apixaban twice daily, and 20 on warfarin (control group). Extractions were scheduled during the lowest DOACs plasma concentration: 14 hours after the last rivaroxaban dose; 8 hours after the last dabigatran/apixaban dose; and with INR values between 2.0 and 3.0 in the warfarin group. Patients returned 24 hours after tooth extraction for evaluation of bleeding.
RESULTS: Fifty-eight patients were included in the study, in a total of 84 tooth extractions. No minor or major bleeding occurred in the rivaroxaban group. Two patients in the dabigatran/apixaban group (11.1%) and two in the control group (10%) presented minor bleeding. There was no statistically significant difference in bleeding rates among the groups (P = .324), and no major bleeding events were reported.
CONCLUSION: These preliminary results suggest that the protocol proposing non-discontinuing DOACs in extractions may be feasible in clinical practice.