Citation Information :
Pirlog CD, Pirlog AM, Maghiar T. A Systematic Review of Hemorrhage Risk in Patients on the New Oral Anticoagulant Therapy Postdental Implant Placement. World J Dent 2019; 10 (2):154-157.
Aim: Dental implant placement is potentially invasive and hemorrhagic. Patients on the new oral anticoagulants (NOAC) have a potential risk of hemorrhage postoperative. The present study systematically reviews if NOAC medication presents the potential to increase the bleeding risk after dental implant placement.
Materials and methods: A systematic review was conducted of randomized clinical trials evaluating the risk of hemorrhage after dental implants in patients taking NOAC medication. The literature search was conducted using Cochrane Central Register of Controlled Trials, PubMed, Science Direct without the restriction of language from June 2010 to December 2018. The inclusion criteria were: anticoagulant therapy, dental implant placement and postoperative incidence of bleeding follow-up. The reviewers performed data extraction, bias risk assessment, and determination of the overall quality of evidence for each of the outcomes using the Jadad scale.
Review results: Two articles regarding the incidence of bleeding risk post dental implant placement were included in the review. The first article showed that one patient from the intervention group and two patients from the control group presented slight bleeding the day after the surgery, with the relative risk of 0.919 and the 95% confidence interval of 0.078–10.844. The second article showed that two patients from the intervention group and two patients from the control group presented slight bleeding the day after the surgery, with the relative risk of 0.675 and the 95% confidence interval of 0.090–5.088.
Conclusion: The results suggested that continuing the intake of NOAC during and post procedure has not increased the hemorrhage risk. Hence, drugs modification or alteration was not necessary.
Clinical significance: More well-designed studies are required for future research.
Becker DE. Antithrombotic drugs: pharmacology and implications for dental practice. Anesth Prog 2013;60(2):72-80.
Nocini PF, Castellani R, Zanotti G, et al. The use of computer-guided flapless dental implant surgery (Nobel Guide) and immediate function to support a fixed full-arch prosthesis in fresh-frozen homologous patients with bone grafts. J Craniofac Surg. 2013;24:e551-e558.
Oral and maxillofacial surgeons: the experts in face, mouth and jaw surgery [Internet] Rosemont (IL): American Association of Oral and Maxillofacial Surgeons; [cited 2014 Apr 21.
Gupta A, Dhanraj M, Sivagami G. Status of surface treatment in endosseous implant: a literary overview. Indian J Dent Res. 2010;21:433-438.
Stangier J, Rathgen K, Stähle H, et al. The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. Br J Clin Pharmacol 2007;64(3):292-303.
Ageno W, Gallus AS, Wittkowsky A, et al. Oral anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 2012 Feb.
Van Ryn J, Stangier J, Haertter S, et al. Dabigatran etexilate – a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 2010;103(6):1116-1127.
Kubitza D, Becka M, Voith B, et al. Safety, pharmacodynamics, and pharmacokinetics of single doses of BAY 59-7939, an oral, direct factor Xa inhibitor. Clin Pharmacol Ther 2005;78(4):412-421.
Gómez-Moreno G, Aguilar-Salvatierra A, Fernández-Cejas E, et al. Dental implant surgery in patients in treatment with the anticoagulant oral rivaroxaban. Clin Oral Implants Res 2016;27(6):730-733.
Gómez-Moreno G, Fernández-Cejas E, Aguilar-Salvatierra A, de Carlos F, Delgado-Ruiz RA, Calvo-Guirado JL. Dental implant surgery in patients in treatment by dabigatran. Clin Oral Implants Res. 2018 Jun;29(6):644-648.
Nice. Https://wwwniceorguk/advice/ktt16. [Online]. Available from: https://www.nice.org.uk/advice/ktt16 [Accessed January 2019]. https://www.aaid.com/about/press_room/dental_implants_faq.html.
American academy of implant dentistry. [Online]. Available from: https://www.aaid.com/about/press_room/dental_implants_faq.html [Accessed January 2019].
Sdceporguk. [Online]. Available from: http://www.sdcep.org.uk/ wp-content/uploads/2015/09/SDCEP-Anticoagulants-Guidance.pdf [Accessed January 2019].
Perry DJ, Noakes TJ, Helliwell PS. Guidelines for the management of patients on oral anticoagulants requiring dental surgery. Br Dent J 2007;203:389-393.
Forbes CD, Barr RD, Reid G, et al. Tranexamic acid in control of haemorrhage after dental extraction in haemophilia and Christmas disease. Br Med J 1972;2(5809):311-313.