Postoperative bleeding after dental extraction among elderly patients under anticoagulant therapy
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ORIGINAL ARTICLE
Postoperative bleeding after dental extraction among elderly patients under anticoagulant therapy Masanao Inokoshi 1 & Kazumasa Kubota 1
&
Eijiro Yamaga 1 & Kaori Ueda 1 & Shunsuke Minakuchi 1
Received: 16 June 2020 / Accepted: 27 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives This study aimed to assess and compare postoperative bleeding occurrence after dental extraction in medically compromised elderly patients under anticoagulant therapy. Materials and methods This retrospective study included medically compromised elderly patients aged ≥ 65 years who were taking apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin and had undergone single or multiple dental extractions. The primary outcome measure was postoperative bleeding occurrence, which was defined as oozing or marked hemorrhage from 24 h to 7 days after dental extraction. Postoperative bleeding occurrence was calculated for each anticoagulant and compared using Fisher’s exact test, followed by multiple comparisons. Results Two hundred thirty-two patients met the inclusion criteria. The highest postoperative bleeding occurrence was recorded for rivaroxaban (12/37: 32.4%), followed by apixaban (8/44: 18.2%), warfarin (17/98: 17.3%), and edoxaban (2/35: 5.7%). Patients taking dabigatran did not present postoperative bleeding (0/18: 0%). Fisher’s exact test, followed by multiple comparison tests, revealed a significant among-anticoagulant difference (p = 0.0095). Postoperative bleeding was significantly higher in patients taking rivaroxaban than in those taking edoxaban or dabigatran (p = 0.03088). Conclusions Within the limitations of this retrospective study design, these findings suggest that different anticoagulants may affect postoperative bleeding occurrence after dental extraction among medically compromised elderly patients. Clinical relevance Clinicians should carefully consider postoperative bleeding after dental extraction in patients taking anticoagulant therapy, especially rivaroxaban. Keywords Anticoagulant . Direct oral anticoagulant . Elderly and medically compromised patients . Postoperative bleeding
Introduction * Kazumasa Kubota [email protected] 1
Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8549, Japan
In 2019, the United Nations (New York, NY, USA) reported that there were 703 million people aged ≥ 65 years worldwide [1], which is projected to reach 1.5 billion by 2050 [1]. Consequently, there will be an increase in the number of elderly patients visiting dental practices. In the elderly population, there is a clear trend where a substantial number of individuals are medically compromised and taking medication.
Clin Oral Invest
Anticoagulants are used to control atrial fibrillation (AF), valvular heart diseases, pulmonary embolism, and deep vein thrombosis. In the past, most anticoagulants were vitamin K antagonists (VKAs). Recently, d
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