Bleeding after tooth extraction range from minor bleeding to life-threating haemorrhagic shock and are among the leading complications in patients under oral anticoagulation with direct oral anticoagulants (DOACs) or phenprocoumon. Little is known about how anticoagulation in patients under DOAC or phenprocoumon alters the characteristics, treatment or outcome of bleeding events, in comparison to non-anticoagulated patients.
Patients admitted to a tertiary ED in Bern, Switzerland, from June 1st 2012 to 31st May 2016 with bleeding related to tooth extraction under DOAC, phenprocoumon or without anticoagulation, were compared.
Out of 161,458 emergency consultations, 64 patients with bleeding from tooth extraction were included in our study. In anticoagulation groups, we found significantly more delayed bleeding events than in patients without anticoagulation (9 (81.3%) DOAC, 19 (86.4%) phenprocoumon, 8 (30.8%) no anticoagulation, p < 0.001). Anticoagulated patients had to stay longer in the ED than non-anticoagulated patients, with no significant difference between DOAC or phenprocoumon (hours: 4.8 (3.2–7.6 IQR) DOAC, 3.0 (2.0–5.5 IQR) phenprocoumon, p = 0.133; 2.7 (1.6–4.6) no anticoagulation; p = 0.039). More patients with anticoagulation therapy needed surgery than patients without anticoagulant therapy (11 (68.8%) DOAC, 12 (54.6%) VKA, p = 0.506; 7(26.9%) no anticoagulation; p = 0.020).
Delayed bleeding occur more often in anticoagulated patients with both DOAC and phenprocoumon compared to patients without anticoagulation. Bleeding events in anticoagulated patients with DOAC and phenprocoumon equally need longer ED treatment and more frequent surgical intervention.
Caution with delayed bleeding in anticoagulated patients with DOACs and phenprocoumon is necessary and treatment of bleeding is resource-demanding.
Sumanth KN, Prashanti E, Aggarwal H, Kumar P, Lingappa A, Muthu MS, Kiran Kumar Krishanappa S (2016) Interventions for treating post-extraction bleeding. Cochrane Database Syst Rev 6:CD011930. https://doi.org/10.1002/14651858.CD011930.pub2 CrossRef
Bacci C, Maglione M, Favero L, Perini A, Di Lenarda R, Berengo M, Zanon E (2010) Management of dental extraction in patients undergoing anticoagulant treatment. Results from a large, multicentre, prospective, case-control study. Thromb Haemost 104(5):972–975. https://doi.org/10.1160/TH10-02-0139 CrossRefPubMed
NICE NICE Clinical Knowledge Summaries - Anticoagulation - oral - Management. https://cks.nice.org.uk/anticoagulation-oral. Accessed Mai 2017
Sauter TC, Amylidi AL, Ricklin ME, Lehmann B, Exadaktylos AK (2016) Direct new oral anticoagulants in the emergency department: experience in everyday clinical practice at a Swiss university hospital. Eur J Intern Med 29:e13–e15. https://doi.org/10.1016/j.ejim.2015.12.009 CrossRefPubMed
Exadaktylos AK, Hautz WE (2015) Emergency medicine in Switzerland. ICU Management & Practice 15(4)
Le Heuzey JY, Ammentorp B, Darius H, De Caterina R, Schilling RJ, Schmitt J, Zamorano JL, Kirchhof P (2014) Differences among western European countries in anticoagulation management of atrial fibrillation. Data from the PREFER IN AF registry. Thromb Haemost 111(5):833–841. https://doi.org/10.1160/TH13-12-1007 CrossRefPubMed
World Health Organization (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity WHO (WHO/NMH/NHD/MNM/11.1). http://www.who.int/vmnis/indicators/haemoglobin.pdf. Accessed 10.06.2017
Miclotte I, Vanhaverbeke M, Agbaje JO, Legrand P, Vanassche T, Verhamme P, Politis C (2016) Pragmatic approach to manage new oral anticoagulants in patients undergoing dental extractions: a prospective case-control study. Clin Oral Investig 21:2183–2188. https://doi.org/10.1007/s00784-016-2010-1 CrossRefPubMed
Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG (1995) Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med 155(5):469–473 CrossRef
Kawashima W, Hatake K, Morimura Y, Kudo R, Nakanishi M, Tamaki S, Kasuda S, Yuui K, Ishitani A (2013) Asphyxial death related to postextraction hematoma in an elderly man. Forensic Sci Int 228(1–3):e47–e49. https://doi.org/10.1016/j.forsciint.2013.02.019 CrossRefPubMed
Sauter TC, Hegazy K, Hautz WE, Krummrey G, Ricklin ME, Nagler M, Borner U, Exadaktylos AK (2017) Epistaxis in anticoagulated patients: fewer hospital admissions and shorter hospital stays on rivaroxaban compared to phenprocoumon. Clin Otolaryngol 43:103–108. https://doi.org/10.1111/coa.12904 CrossRefPubMed
- Characteristics, treatment and outcome of bleeding after tooth extraction in patients on DOAC and phenprocoumon compared to non-anticoagulated patients—a retrospective study of emergency department consultations
Aristomenis K. Exadaktylos
Thomas C. Sauter
- Springer Berlin Heidelberg
Clinical Oral Investigations
Print ISSN: 1432-6981
Elektronische ISSN: 1436-3771
Neu im Fachgebiet Zahnmedizin
Mail Icon II