Direct Acting Oral Anticoagulants and their Implications in Dental Extraction: A Systematic Review

2021 • Volume 15 • Issue 3

Alice Cáceres R.; Luis Areyuna C. & Liberto Figueroa C.



The use of Direct Acting Oral Anticoagulants (ACOD) has increased considerably in recent times. In dental procedures, such as tooth extraction, optimal management of hemostasis in patients treated with ACOD is crucial to balance the risk of bleeding and thromboembolism. There is still no consensus on the protocol to be applied in patients with ACOD in dental extraction. The aim was to evaluate the need to suspend or continue treatment with ACOD in patients submitted to dental extraction in relation to the incidence of bleeding episodes and the protocols used. A systematic review was carried out based on the PRISMA estates, in the Pubmed, Wiley, Scopus databases. The search included studies published between 2010-2020 in English conducted in humans, in patients under therapy with ACOD submitted to dental extraction and that evaluate the incidence of bleeding in this procedure. Studies involving patients receiving other concomitant antithrombotic treatments or procedures other than dental extraction were excluded. The quality of the selected studies was evaluated according to the Oxford Center for Evidence-based Medicine classification. After the search, based on inclusion/exclusion criteria, 34 articles were analyzed in full text. 13 relevant articles were selected. 11 participated in the final review, including 8 cohort studies, 2 case-controls and 1 case series. Studies show that it is not necessary to suspend therapy with ACOD in patients who have undergone dental extraction, it is suggested that the moment of low pharmacological concentration can be used in favor of the treatment. However, there is a great diversity of protocols and measures applied between studies, so it is necessary to carry out randomized controlled clinical studies to determine a standard protocol in the dental management of these patients.

KEY WORDS: tooth extraction, anticoagulants [pharmacological action]), factor xa inhibitors, dabigatran, postoperative hemorrhage.


How to cite this article

CÁCERES, R. A.; AREYUNA, C. L. & FIGUEROA, C. L. Direct acting oral anticoagulants and their implications in dental extraction: A systematic review. Int. J. Odontostomat., 15(3):646-652, 2021.


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