The comparasion between effects of new types of oral anticoagulants on bleeding after tooth extraction

Anticoagulants are commonly used drugs in patients at risk of venous thromboembolism (history of previous thromboembolism, immobilized patients, major surgery, pregnancy etc.) or at risk of embolic stroke (atrial fibrillation patients, prosthetic heart valve carriers). Warfarin is the most commonly prescribed oral anticoagulant however it has many disadvantages such as delayed onset of action, need of dosage regulation, interaction between some food or another drugs and need of regular monitorisation. In order to eliminate such disadvantages and difficulties new generation oral anticoagulants dabigatran etexilate (direct trombin inhibitor), rivaroxaban and apixaban (Faktör X inhibitors) were developed. The management of patients taking warfarin who require dental extractions/oral surgery is well known in the literature. However, only limited amount of clinical studies taking new generation oral anticoagulants who require dental extractions/oral surgery have been documented. The aim of this prospective, observational study is to compare the amount of bleeding and postoperative complications after dental extractions in patients taking warfarin, direct thrombin inhibitors and factor Xa inhibitors. The study was composed of 3 study groups and a control group: Group 1 (n=17): Patients taking direct thrombin inhibitor (dabigatran etexilate), Group 2 (n=21): Patients taking direct factor Xa inhibitor (either rivaroxaban or apixaban) Group 3 (n=22): Patients taking warfarin Group 4 (n=24): Patients taking no anticoagulants (control group). The amount of bleeding were measured among all groups during 20 minutes period following tooth extraction. Local heamostatic agents were used in all groups after the measurements. The bleeding complications were evaluated on the 2nd and 7th postoperative day. The amount of bleeding and the complications were compared statistically among groups. The outcome of the present study showed that, there is not any significant risk of bleeding after tooth extraction without stopping of oral anticoagulant medication. There was not statistically significant differences between new generation oral anticoagulants (Group 1 and Group 2) and control group in terms of amount of bleeding and bleeding complications. On the other hand, significantly more amount of bleeding was measured in warfarin group when compared with the other groups. In conclusion, there is no need to stop or change the new generation oral anticoagulant therapy before the procedures with minor bleeding risk such as tooth extraction . However, INR of the patients on coumadin should be evaluated before tooth extraction. Key Words: Tooth Extraction, Warfarin, Bleeding, New Generation Oral Anticoagulants