Abstract
Introduction
Comparative safety of direct oral anticoagulants vs. warfarin in patients undergoing tooth extraction remains unclear. We compared the
incidence of post-extraction bleeding between patients taking warfarin and those taking
direct oral anticoagulants (DOACs) using administrative claims data.
Materials and methods
We identified outpatients on anticoagulant therapy who underwent permanent tooth extraction
between 2015 and 2020 and categorized them into the warfarin and DOAC groups based
on medication prescribed within six months prior to tooth extraction. We used the
overlap propensity score weighting method to balance the baseline characteristics
between the groups and compared the incidence of post-extraction bleeding within seven
days after tooth extraction.
Results
Among 5253 eligible patients, those in the DOAC group (n = 3696) were older and less
frequently prescribed antiplatelets than those in the warfarin group (n = 1557). The
distribution of tooth extraction type and number of teeth extracted in a single procedure
did not differ between the groups. The unadjusted incidences of post-extraction bleeding
in the warfarin and DOAC groups were 35 (2.2 %) and 71 (1.9 %), respectively. Moreover,
the overlap weighting analysis showed that the adjusted odds ratio of post-extraction
bleeding in the DOAC group in comparison with that in the warfarin group was 0.84
(95 % confidence interval, 0.54–1.31).
Conclusion
The incidence of post-extraction bleeding in patients taking DOACs was comparable
to that in patients taking warfarin. The findings suggest that dentists and physicians
should exercise the same degree of caution when extracting teeth in patients on DOACs
and those on warfarin in terms of post-extraction bleeding.
Keywords
Abbreviations:
DOAC (direct oral anticoagulant), PT-INR (prothrombin time and international normalized ratio)To read this article in full you will need to make a payment
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References
- Oral anticoagulant prescription trends, profile use, and determinants of adherence in patients with atrial fibrillation.Pharmacotherapy. 2020; 40: 40-54https://doi.org/10.1002/phar.2350
- Trends in anticoagulant prescribing: a review of local policies in english primary care.BMC Health Serv. Res. 2020; 20: 279https://doi.org/10.1186/s12913-020-5058-1
- Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.N. Engl. J. Med. 2011; 365: 883-891https://doi.org/10.1056/NEJMoa1009638
- Apixaban versus warfarin in patients with atrial fibrillation.N. Engl. J. Med. 2011; 365: 981-992https://doi.org/10.1056/NEJMoa1107039
- Asphyxial death caused by postextraction hematoma.Am J Forensic Med Pathol. 1994; 15: 87-90https://doi.org/10.1097/00000433-199403000-00018
- Interventions for treating post-extraction bleeding.Cochrane Database Syst. Rev. 2018; 3CD011930https://doi.org/10.1002/14651858.CD011930.pub3
- Bleeding complications in anticoagulated and/or antiplatelet-treated patients at the dental office: a retrospective study.Int. J. Environ. Res. Public Health. 2021; 18: 1609https://doi.org/10.3390/ijerph18041609
- Postoperative bleeding after dental extraction among elderly patients under anticoagulant therapy.Clin. Oral Investig. 2021; 25: 2363-2371https://doi.org/10.1007/s00784-020-03559-z
- Risks of postextraction bleeding after receiving direct oral anticoagulants or warfarin: a retrospective cohort study.BMJ Open. 2017; 7e015952https://doi.org/10.1136/bmjopen-2017-015952
- Dental extractions on direct oral anticoagulants vs. warfarin: the DENTST study.Res. Pract. Thromb. Haemost. 2020; 4: 278-284https://doi.org/10.1002/rth2.12307
- Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study.Clin. Oral Investig. 2019; 23: 3183-3192https://doi.org/10.1007/s00784-018-2739-9
- Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study.Int. J. Oral Maxillofac. Surg. 2019; 48: 1102-1108https://doi.org/10.1016/j.ijom.2019.01.013
- Assessing an oral surgery specific protocol for patients on direct oral anticoagulants: a retrospective controlled cohort study.Int. J. Oral Maxillofac. Surg. 2018; 47: 940-946https://doi.org/10.1016/j.ijom.2018.03.009
- Perioperative management in patients with undergoing direct oral anticoagulant therapy in oral surgery – a multicentric questionnaire survey.In Vivo. 2019; 33: 855-862https://doi.org/10.21873/invivo.11550
- Prevalence of non-communicable diseases in Japan using a newly developed administrative claims database covering young, middle-aged, and elderly people.JMAJ. 2022; 5: 190-198https://doi.org/10.31662/jmaj.2021-0189
- Validity of diagnoses, procedures, and laboratory data in japanese administrative data.J. Epidemiol. 2017; 27: 476-482https://doi.org/10.1016/j.je.2016.09.009
- Validity of diagnoses and procedures in japanese dental claims data.BMC Health Serv. Res. 2021; 21: 1116https://doi.org/10.1186/s12913-021-07135-3
- Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.Med. Care. 2005; 43: 1130-1139https://doi.org/10.1097/01.mlr.0000182534.19832.83
- Translating claims-based CHA 2 DS 2 -VaSc and HAS-BLED to ICD-10-CM: impacts of mapping strategies.Pharmacoepidemiol. Drug Saf. 2020; 29: 409-418https://doi.org/10.1002/pds.4973
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav. Res. 2011; 46: 399-424https://doi.org/10.1080/00273171.2011.568786
- Propensity score weighting analysis and treatment effect discovery.Stat. Methods Med. Res. 2019; 28: 2439-2454https://doi.org/10.1177/0962280218781171
- Balancing covariates via propensity score weighting.J. Am. Stat. Assoc. 2018; 113: 390-400https://doi.org/10.1080/01621459.2016.1260466
- Overlap weighting: a propensity score method that mimics attributes of a randomized clinical trial.JAMA. 2020; 323: 2417-2418https://doi.org/10.1001/jama.2020.7819
- Addressing extreme propensity scores via the overlap weights.Am. J. Epidemiol. 2018; 188: 250-257https://doi.org/10.1093/aje/kwy201
- Statistical Analysis With Missing Data.second ed. Wiley, New York2002
- Multiple Imputation for Nonresponse in Surveys.Wiley, New York1987
- American College of Surgeons’ guidelines for the perioperative management of antithrombotic medication.J. Am. Coll. Surg. 2018; 227: 521-536.e1https://doi.org/10.1016/j.jamcollsurg.2018.08.183
- Perioperative management of patients on direct oral anticoagulants.Thromb. J. 2017; 15: 14https://doi.org/10.1186/s12959-017-0137-1
- Perioperative management of patients on new oral anticoagulants.Br. J. Surg. 2014; 101: 742-749https://doi.org/10.1002/bjs.9485
- British dental society, guidelines for the management of patients on oral anticoagulants requiring dental surgery.Br. Dent. J. 2007; 203: 389-393https://doi.org/10.1038/bdj.2007.892
- The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation.Eur. Heart J. 2018; 39: 1330-1393https://doi.org/10.1093/eurheartj/ehy136
- Japanese Society of Oral and Maxillofacial Surgeons, Japanese Society of Gerodontology, Extraction of Teeth in Patients on Antithrombotic Therapy.Gakujutsusya, 2015
- The use of direct oral anticoagulants in chronic kidney disease.Br. J. Haematol. 2018; 183: 170-184https://doi.org/10.1111/bjh.15564
- Assessing patient preferences for switching from warfarin to direct oral anticoagulants.J. Thromb. Thrombolysis. 2019; 48: 596-602https://doi.org/10.1007/s11239-019-01915-9
- Anticoagulant preferences and concerns among venous thromboembolism patients.Thromb. Haemost. 2018; 118: 553-561https://doi.org/10.1055/s-0038-1625985
- Dental treatment procedures for periodontal disease and the subsequent risk of ischaemic stroke: a retrospective population-based cohort study.J. Clin. Periodontol. 2019; 46: 642-649https://doi.org/10.1111/jcpe.13113
- Management of dental extraction in patients undergoing anticoagulant oral direct treatment: a pilot study.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2016; 122 (e146–e155)https://doi.org/10.1016/j.oooo.2016.06.003
Article info
Publication history
Published online: December 19, 2022
Accepted:
December 14,
2022
Received in revised form:
November 22,
2022
Received:
August 10,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
