Bleeding complications after tooth extractions in patients taking oral anticoagulant, simple or dual antiplatelet therapy. A retrospective study

Background and aim: Due to the increasing life expectancy and the ageing of the population, dental management of patients taking oral anticoagulant or antiplatelet therapy for the prevention of cardiovascular and celebrovascular diseases is an increasingly common clinical problem. The aim of this study was the evaluation of the effect of oral anticoagulant or antiplatelet therapy in patients who underwent tooth extractions in the Dental Clinic of University General Hospital of Heraklion, from January to December 2019. Methods: This was a retrospective study. Data were obtained from the dental records maintained at the Clinic. They included gender, age, medical history, type of anticoagulant or antiplatelet therapy, dental procedures and postoperative bleeding. All statistical controls were performed using SPSS, Version 24.0. Results: 178 individual patients (114 males and 64 females) taking oral anticoagulant, simple or dual antiplatelet therapy were treated in the Dental Clinic. They underwent 699 tooth extractions in 267 sessions. 41 patients taking oral anticoagulants underwent 119 simple and surgical tooth extractions in 58 sessions. All patients had an INR value within therapeutic range. 109 patients taking simple antiplatelet therapy (78 aspirin, 31 clopidogrel) underwent 451 simple and surgical tooth extractions in 166 sessions. 28 patients receiving dual antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg) underwent 129 simple and surgical tooth extractions in 43 sessions. Local hemostatic measures, such as suturing and collagen sponges, were applied in all cases. Detailed instructions were given to all patients after operation. 5 patients had bleeding complications. All of them were taking oral anticoagulant therapy. All complications were controlled with local hemostatic measures as pressing with a gauge, new suturing, collagen sponges and mouthwashes with tranexamic acid. Conclusions: Patients taking oral anticoagulants with an INR value within therapeutic range and patients taking simple or dual antiplatelet therapy may undergo tooth extractions without interruption of their treatment. Appropriate local hemostatic measures must be provided in advance. Cases of bleeding complications are easily controlled with local hemostatic measures.