Maddalena Manfredi1, Bella Dave2, Daniela Percudani3, Janina Christoforou4, Jumana Karasneh5, Pedro Diz Dios6, Michael Glick7, Navdeep Kumar8, Peter B Lockhart9, Lauren L Patton10. 1. Dipartimento di Medicina e Chirurgia, University of Parma, Parma, Italy. 2. Department of Oral Medicine, Leeds Dental Institute, Leeds, West Yorkshire, UK. 3. University of Parma, Parma, Italy. 4. University of Western Australia, Perth, Western Australia, Australia. 5. Department of Oral Medicine and Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. 6. Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain. 7. School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, New York. 8. Cert Surg & Pros Implantology, Eastman Dental Hospital for Oral Healthcare Sciences, London, UK. 9. Carolinas Medical Center, Charlotte, North Carolina. 10. University of North Carolina, Chapel Hill, North Carolina.
Abstract
OBJECTIVES: This systematic review aimed to evaluate the current literature regarding the importance of discontinuing or not discontinuing direct oral anticoagulants (DOACs) before invasive oral procedures, and to establish the frequency and type of postoperative bleeding events in patients. MATERIAL AND METHODS: We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up until November 5, 2018. Selection of the studies, extraction of data, qualitative, and bias assessment was performed independently by two authors. RESULTS: Twenty-one studies were included. No randomized controlled studies were identified. Six studies reported a direct comparison between patients taking DOACs and those who discontinued DOACs. The meta-analysis of these studies resulted in an OR of 0.92 (95% CI = 0.37-2.27, I2 = 9%) for postoperative bleeding events for patients taking DOACs. We found that 59/497 (11.8%) postoperative bleeding events occurred in patients who continued DOACs, while 27/200 (13.5%) events were reported for patients who discontinued treatment. All postoperative bleeding events were controlled with local measures. CONCLUSION: Results from the included studies did not discern any important differences in postoperative bleeding events in patients who continued versus patients who discontinued DOACs. Furthermore, no thromboembolic events were recorded. However, the low quality of the studies must be considered.
OBJECTIVES: This systematic review aimed to evaluate the current literature regarding the importance of discontinuing or not discontinuing direct oral anticoagulants (DOACs) before invasive oral procedures, and to establish the frequency and type of postoperative bleeding events in patients. MATERIAL AND METHODS: We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up until November 5, 2018. Selection of the studies, extraction of data, qualitative, and bias assessment was performed independently by two authors. RESULTS: Twenty-one studies were included. No randomized controlled studies were identified. Six studies reported a direct comparison between patients taking DOACs and those who discontinued DOACs. The meta-analysis of these studies resulted in an OR of 0.92 (95% CI = 0.37-2.27, I2 = 9%) for postoperative bleeding events for patients taking DOACs. We found that 59/497 (11.8%) postoperative bleeding events occurred in patients who continued DOACs, while 27/200 (13.5%) events were reported for patients who discontinued treatment. All postoperative bleeding events were controlled with local measures. CONCLUSION: Results from the included studies did not discern any important differences in postoperative bleeding events in patients who continued versus patients who discontinued DOACs. Furthermore, no thromboembolic events were recorded. However, the low quality of the studies must be considered.
Authors: Esther Martínez-Moreno; Federico Martínez-López; Francisco Javier Rodríguez-Lozano; Ricardo Elías Oñate-Sánchez Journal: Int J Environ Res Public Health Date: 2021-02-08 Impact factor: 3.390