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Impact of direct oral anticoagulants on bleeding tendency and postoperative complications in oral surgery: a systematic review of controlled studies
Malmö University, Faculty of Odontology (OD).ORCID iD: 0000-0002-0730-1020
Malmö University, Faculty of Odontology (OD).ORCID iD: 0000-0002-6337-4988
Department of Vascular Diseases and HTA Syd, Skåne University Hospital, Malmö/Lund, Sweden.
Malmö University, Faculty of Odontology (OD).ORCID iD: 0000-0003-2597-1025
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2023 (English)In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 135, no 3, p. 333-346, article id S2212-4403(22)01047-1Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The recommendations for the management of direct oral anticoagulants (DOACs) in oral surgery are inconsistent. The present review evaluated whether DOACs increase the risk of bleeding during oral surgery and postoperative complications.

STUDY DESIGN: The patients undergoing oral surgery and receiving a DOAC were compared with the patients receiving a DOAC different from the exposure, a vitamin K antagonist (VKA), or no anticoagulant. Three electronic databases were searched for eligible clinical trials and systematic reviews. The risk of bias was assessed, data were extracted, a meta-analysis was done, and the Grading of Recommendations, Assessment, Development and Evaluations certainty-of-evidence ratings were determined.

RESULTS: Three clinical trials comparing patients receiving DOAC medication with patients on a VKA were eligible. A meta-analysis of bleeding 7 days postoperatively detected no significant differences between patients continuing DOAC or VKA medication during and after surgery. All of the point estimates favored uninterrupted DOAC over VKA therapy. Tranexamic acid was topically administered to some patients.

CONCLUSIONS: Based on an interpreted trend among 3 studies with mixed patient populations, the risk of bleeding during the first 7 postoperative days may be lower for patients on uninterrupted DOAC than VKA therapy (⨁⨁⭘⭘), but the effect size of the risk is unclear. 80 of 274 included patients experienced postoperative bleeding.

Place, publisher, year, edition, pages
Elsevier, 2023. Vol. 135, no 3, p. 333-346, article id S2212-4403(22)01047-1
National Category
Dentistry
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URN: urn:nbn:se:mau:diva-56338DOI: 10.1016/j.oooo.2022.07.003ISI: 000990228100001PubMedID: 36100547Scopus ID: 2-s2.0-85137711821OAI: oai:DiVA.org:mau-56338DiVA, id: diva2:1715164
Available from: 2022-12-01 Created: 2022-12-01 Last updated: 2024-05-21Bibliographically approved

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Johansson, KristerGötrick, BengtTranæus, SofiaNaimi-Akbar, Aron

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