MANAGEMENT OF TOOTH EXTRACTIONS IN PATIENTS RECEIVING THE NEW ORAL ANTICOAGULANTS

Introduction: High bleeding risk procedures pose a serious challenge for dental practitioners treating patients taking some of the novel oral anticoagulants. Aim: The aim of the present study was to assess clinically the bleeding risk in a typical tooth extraction in patients on monotherapy with one of the new oral anticoagulants rivaroxaban (Xarelto), apixaban (Eliquis), and dabigatran (Pradaxa). Materials and methods: The study included 30 patients on these anticoagulants who underwent a typical tooth extraction. Local hemostasis was achieved using Surgicel, Haemocollagen or Gelaspon, and suturing the edges of the wound. Clinical evaluation of the bleeding was performed at 10 and 30 minutes, and 24 hours after the extraction. Anticoagulants were discontinued for the day of extraction. Results: Post-extraction bleeding in the first 10 minutes was observed in 17 patients (56.66%). Bleeding within 30 minutes was observed in 11 patients (36.66%). Two (6.66%) patients reported having only mild oozing within 24 hours. No additional haemostasis was required for any of the patients. Bleeding in a typical tooth extraction is of capillary origin. Bleeding sites are easily accessible and local hemostatic agents are effective enough to control the bleeding. Discontinuation of the anticoagulant on the day of extraction is sufficient to prevent any adverse events. No abnormal post-extraction bleeding was observed in our study. Conclusions: If tooth extraction is required in patients taking the new oral anticoagulants rivaroxaban (Xarelto), apixaban (Eliquis) or dabigatran (Pradaxa), the patient can cease the reception of the drug only for the day of the procedure.