Risk of Bleeding during Implant Surgery in Patients Taking Antithrombotics: A Systematic Review

Abstract The objective of this systematic review is to assess the risk of postoperative bleeding in oral surgery for implant placement in individuals taking antithrombotics (i.e., anticoagulants and/or antiplatelet agents). A literature search was performed in PubMed (MEDLINE), Web of Science, Scopus, and EMBASE databases for articles published until August 2020, with no date restriction, and manually completed. We included prospective clinical studies that provided information regarding the presence of an experimental group (i.e., implant placement), a control group (patients not under treatment with antithrombotics), and a well-established protocol for evaluating bleeding. Meta-analysis determined the risk of bleeding during the placement of implants in antithrombotic-treated patients. Of the 756 potentially eligible articles, 5 were included in the analysis with 4 ranked as high and 1 as medium quality. Antithrombotic treatment comprised the following drug classes: (1) anticoagulants: vitamin K antagonists, (2) nonvitamin K antagonist oral anticoagulants, (3) low-molecular-weight heparin, and (4) antiplatelet agents (not specified). The results suggest that the risk of bleeding is not substantially higher in antithrombotic-treated patients (odds ratio = 2.19; 95% confidence interval: 0.88–5.44, p = 0.09) compared with nontreated patients. This systematic review suggests that the absolute risk is low and there is no need to discontinue or alter the dose of the antithrombotic treatment for implant placement surgery.

[1]  Craig S. Miller,et al.  Dental implant surgery and risk of bleeding in patients on antithrombotic medications: a review of the literature. , 2020, Oral surgery, oral medicine, oral pathology and oral radiology.

[2]  D. Dornbos,et al.  Reversal of Systemic Anticoagulants and Antiplatelet Therapeutics. , 2018, Neurosurgery clinics of North America.

[3]  Y. Anavi,et al.  Complications and Management of Implants Migrated into the Maxillary Sinus. , 2018, The International journal of periodontics & restorative dentistry.

[4]  U. Reebye,et al.  Review: An overview and analysis of novel oral anticoagulants and their dental implications , 2018, Gerodontology.

[5]  G. Gómez-Moreno,et al.  Dental implant surgery in patients in treatment by dabigatran , 2018, Clinical oral implants research.

[6]  D. Polak,et al.  Dental treatment in the era of new anti-thrombotic agents. , 2017, International dental journal.

[7]  C. Dézsi,et al.  Management of dental patients receiving antiplatelet therapy or chronic oral anticoagulation: A review of the latest evidence , 2017, The European journal of general practice.

[8]  Bin Zhang,et al.  Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies , 2017, Frontiers in pharmacology.

[9]  B. Rusche,et al.  Management of anticoagulated patients in implant therapy: a clinical comparative study. , 2016, Clinical oral implants research.

[10]  G. Gómez-Moreno,et al.  Dental implant surgery in patients in treatment with the anticoagulant oral rivaroxaban. , 2016, Clinical oral implants research.

[11]  A. John Camm,et al.  Novel anticoagulants and antiplatelet agents; a guide for the urologist , 2015, BJU international.

[12]  B. Milekic,et al.  Risk factors for bleeding after oral surgery in patients who continued using oral anticoagulant therapy. , 2015, Journal of the American Dental Association.

[13]  B. Frerich,et al.  Oral surgery during therapy with anticoagulants—a systematic review , 2015, Clinical Oral Investigations.

[14]  R. Lalla,et al.  Dental surgery in anticoagulated patients--stop the interruption. , 2015, Oral surgery, oral medicine, oral pathology and oral radiology.

[15]  G. Yamane,et al.  Evaluation of postextraction bleeding incidence to compare patients receiving and not receiving warfarin therapy: a cross-sectional, multicentre, observational study , 2014, BMJ Open.

[16]  R. Bos,et al.  Risk of bleeding after dentoalveolar surgery in patients taking anticoagulants. , 2014, The British journal of oral & maxillofacial surgery.

[17]  A. Baird,et al.  Tutorial in oral antithrombotic therapy: Biology and dental implications , 2013, Medicina oral, patologia oral y cirugia bucal.

[18]  F. J. Firriolo,et al.  Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. , 2012, Oral surgery, oral medicine, oral pathology and oral radiology.

[19]  E. Zanon,et al.  Safety of dental implant surgery in patients undergoing anticoagulation therapy: a prospective case-control study. , 2011, Clinical oral implants research.

[20]  L. Chambrone,et al.  Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies. , 2010, Journal of clinical periodontology.

[21]  M. Sanz,et al.  What influence do anticoagulants have on oral implant therapy? A systematic review. , 2009, Clinical oral implants research.

[22]  M. Effron,et al.  Dual (Anticoagulant Plus Single Antiplatelet) vs Triple (Anticoagulant Plus Dual Antiplatelet) Antithrombotic Therapy - "Real World" Experience. , 2018, Progress in cardiovascular diseases.

[23]  Stefano Federici,et al.  Extracting neurophysiological signals reflecting users' emotional and affective responses to BCI use: A systematic literature review. , 2015, NeuroRehabilitation.