Oral surgery in patients with classic and direct oral anticoagulants: a literature review
DOI:
https://doi.org/10.20453/reh.v35i2.6464Keywords:
anticoagulants, oral surgery, blood coagulation, dentistryAbstract
For decades, vitamin K antagonists such as warfarin have been the standard anticoagulant treatment, despite the clinical management challenges they present. In contrast, direct oral anticoagulants (DOACs) offer fewer complications and therapeutic advantages. These are classified into thrombin inhibitors (dabigatran) and factor Xa inhibitors (rivaroxaban, apixaban, edoxaban). Approximately 10% of anticoagulated patients will require some form of surgery, including oral surgery. In this context, the objective of this review was to update oral surgical management in anticoagulated patients and to familiarize dentists with protocols for warfarin and DOAC users. Discontinuing anticoagulant therapy carries significant and even fatal risks, which in many cases outweigh the benefits of reducing bleeding during oral surgery. It is concluded that anticoagulant therapy should only be suspended for procedures with a high risk of bleeding, and it is essential to evaluate the bleeding risk of the procedure beforehand and apply hemostatic measures when necessary.
Downloads
References
Hiroshi I, Natsuko SY, Yutaka I, Masayori S, Hiroyuki N, Hirohisa I. Frequency of hemorrhage after tooth extraction in patients treated with a direct oral anticoagulant: a multicenter cross-sectional study. PLoS ONE [Internet]. 2022; 17(4): e0266011. Disponible en: https://doi.org/10.1371/journal.pone.0266011
Barros BL, Vasconcelos AF, Barros GL, Medeiros MD. Drogas antiagregantes plaquetárias e anticoagulantes em pacientes que se submeterão à cirurgia oral: conduta. Rev Cir Traumatol Buco-Maxilo-Fac [Internet]. 2022; 22(3): 58-63. Disponible en: https://www.revistacirurgiabmf.com/2022/03/Artigos/10ACDrogasantiagregantesplaquetarias.pdf
Da Silva TE, De Araújo EC, Rocha MP, De Oliveira LM. Manejo cirúrgico do paciente submetido à terapia anticoagulante oral. Rev Pró-Uni [Internet]. 2019; 10(1): 145-149. Disponible en: https://doi.org/10.21727/rpu.v10i1.1751
González F, Álvarez A, Torres J, Fernández-Tresguerres I. Nuevos anticoagulantes orales: repercusión odontológica. Cient Dent [Internet]. 2016; 13(2): 139-148. Disponible en: https://coem.org.es/pdf/publicaciones/cientifica/vol13num2/9.NuevosAnticoagulantes.pdf
Moreno-Drada JA, Abreu LG, Lino PA, Martins MA, Pordeus IA, Abreu MH. Effectiveness of local hemostatic to prevent bleeding in dental patients on anticoagulation: a systematic review and network meta-analysis. J Craniomaxillofac Surg [Internet]. 2021; 49(7): 570-583. Disponible en: https://doi.org/10.1016/j.jcms.2021.04.014
Steed MB, Swanson MT. Warfarin and newer agents: what the oral surgeon needs to know. Oral Maxillofac Surg Clin North Am [Internet]. 2016; 28(4): 515-521. Disponible en: https://doi.org/10.1016/j.coms.2016.06.011
Hall JE. Guyton y Hall. Tratado de fisiología médica. 13.ª ed. Barcelona: Elsevier; 2017.
Silverthorn DU. Fisiologia humana: uma abordagem integrada. 7.ª ed. Porto Alegre: Artmed; 2017.
Elango K, Javaid A, Khetarpal BK, Ramalingam S, Kolandaivel KP, Gunasekaran K, et al. The effects of warfarin and direct oral anticoagulants on systemic vascular calcification: a review. Cells [Internet]. 2021; 10(4): 773. Disponible en: https://doi.org/10.3390/cells10040773
Wan H, Yang Y, Zhu J, Wu S, Zhou Z, Huang B, et al. An in-vitro evaluation of direct thrombin inhibitor and factor Xa inhibitor on tissue factor-induced thrombin generation and platelet aggregation: a comparison of dabigatran and rivaroxaban. Blood Coagul Fibrinolysis [Internet]. 2016; 27(8): 882-885. Disponible en: https://doi.org/10.1097/mbc.0000000000000509
Berkovits A, Mezzano D. Nuevos anticoagulantes orales: actualización. Rev Chil Cardiol [Internet]. 2017; 36(3): 254-263. Disponible en: http://dx.doi.org/10.4067/S0718-85602017000300254
Sequeira CM, Lin EL, Navarro MJ. Generalidades y actualización del manejo de anticoagulantes en procedimientos urgentes y electivos. Ciencia & Salud [Internet]. 2023; 7(4): 67-85. Disponible en: https://doi.org/10.34192/cienciaysalud.v7i4.648
Stanifer JW, Pokorney SD, Chertow GM, Hohnloser SH, Wojdyla DM, Garonzik S, et al. Apixaban versus warfarin in patients with atrial fibrillation and advanced chronic kidney disease. Circulation [Internet]. 2020; 141(17): 1384-1392. Disponible en: https://doi.org/10.1161/circulationaha.119.044059
Chen A, Stecker E, Warden BA. Direct oral anticoagulant use: a practical guide to common clinical challenges. J Am Heart Assoc [Internet]. 2020; 9(13): e017559. Disponible en: https://doi.org/10.1161/jaha.120.017559
Alcalai R, Butnaru A, Moravsky G, Yagel O, Rashad R, Ibrahimli M, et al. Apixaban vs. warfarin in patients with left ventricular thrombus: a prospective multicentre randomized clinical trial. Eur Heart J Cardiovasc Pharmacother [Internet]. 2022; 8(7): 660-667. Disponible en: https://doi.org/10.1093/ehjcvp/pvab057
Kwak EJ, Nam S, Park KM, Kim SY, Huh J, Park W. Bleeding related to dental treatment in patients taking novel oral anticoagulants (NOACs): a retrospective study. Clin Oral Investig [Internet]. 2019; 23(1): 477-484. Disponible en: https://doi.org/10.1007/s00784-018-2458-2
Polo-García J. Nuevos anticoagulantes frente a anticoagulantes clásicos: ventajas e inconvenientes. Semergen [Internet]. 2013; 39(supl. 1): 10-16. Disponible en: https://www.elsevier.es/es-revista-medicina-familia-semergen-40-articulo-nuevos-anticoagulantes-frente-anticoagulantes-clasicos-S1138359313743764
Serrano-Sánchez V, Ripollés-de Ramón J, Collado-Yurrita L, Vaello-Checa I, Colmenero-Ruiz C, Helm A, et al. New horizons in anticoagulation: Direct oral anticoagulants and their implications in oral surgery. Med Oral Patol Oral Cir Bucal [Internet]. 2017; 22(5): e601-e608. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC5694183/
Halaszynski TM. Administration of coagulation-altering therapy in the patient presenting for oral health and maxillofacial surgery. Oral Maxillofac Surg Clin North Am [Internet]. 2016; 28(4): 443-460. Disponible en: https://doi.org/10.1016/j.coms.2016.06.005
Mariano LB, Barcellos BM, da Silveira IT, Duarte BG, Mariotto LG, Yaedú RY. Avaliação da necessidade de suspensão dos novos anticoagulantes orais para a realização de exodontias: revisão sistemática. Res Soc Dev [Internet]. 2023; 12(1): e28012139387. Disponible en: https://doi.org/10.33448/rsd-v12i1.39387
Ockerman A, Miclotte I, Vanhaverbeke M, Vanassche T, Belmans A, Vanhove J, et al. Tranexamic acid and bleeding in patients treated with non-vitamin K oral anticoagulants undergoing dental extraction: the EXTRACT-NOAC randomized clinical trial. PLoS Med [Internet]. 2021; 18(5): e1003601. Disponible en: https://doi.org/10.1371/journal.pmed.1003601
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Carlos Eduardo Alfaro Pacheco, Ana Cristina López-Torres
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the copyright and cede to the journal the right of first publication, with the work registered with the Creative Commons License, which allows third parties to use what is published as long as they mention the authorship of the work, and to the first publication in this journal.
