These agents offer several benefits over traditional vitamin K antagonists (VKAs), including fewer drug–food interactions, a predictable dose–response profile, and no need for routine INR monitoring.
However, their implications for dental procedures, particularly tooth extractions, remain a growing concern among oral surgeons and general dentists alike.
DOACs exert anticoagulant effects by inhibiting thrombin or factor Xa, increasing the risk of post-operative bleeding. Yet, clinical guidelines regarding the perioperative management of these patients during dental extractions are still evolving.
Should treatment be paused or maintained? How can bleeding be minimized without compromising cardiovascular safety?
A recent prospective cohort study by Izzetti et al., published in the Dentistry Journal (2024), provides timely insights into this clinical dilemma.
The study followed 49 patients on various DOACs who underwent dental extractions, assessing both intra-operative and post-operative bleeding.
It identified key risk factors for bleeding, including the number of teeth extracted, surgical complexity (flap elevation and osteotomy), and specific anticoagulants used—particularly rivaroxaban and apixaban.
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Interestingly, temporary suspension of DOACs was associated with a decrease in intraoperative bleeding but had no significant impact on post-operative bleeding
These findings underscore the importance of individualized risk assessment and the effectiveness of local hemostatic measures, even when anticoagulation is maintained.
This study contributes to the growing body of evidence supporting safe dental extractions without DOAC interruption in selected cases, offering clinicians a clearer path through a previously uncertain clinical landscape.
👉 We invite dentists around the world to explore the Full article in PDF and update their clinical approach to anticoagulated patients.
