Evidence map›Paper›PMID 40221663›Full record

Observational studyBMC oral health2025

Continuous use of direct oral anticoagulants during and after simple and surgical tooth extractions: a prospective clinical cohort study.

Krister Johansson, Jonas P Becktor, Aron Naimi-Akbar, Peter J Svensson, Bengt Götrick

Registry-linked trialAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC oral health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04662515 (Novel Oral Anticoagulants in Oral and Maxillofacial Surgery), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04662515 completednot on this map

Novel Oral Anticoagulants in Oral and Maxillofacial Surgery: Impact on Bleeding Tendency, Surgical Difficulty and Post-operative Complications

TypeobservationalSponsorMalmö UniversityRan2016 to 2023Enrolled216ConditionsSurgery, Oral, Hemorrhage, Postoperative Complications, Oral Surgical ProceduresArmsType of surgery, Dabigatran, Rivaroxaban, Apixaban, Edoxaban
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Krister JohanssonDepartment of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden. krister.johansson@mau.se.
Jonas P BecktorDepartment of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden.
Aron Naimi-AkbarDepartment of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden.
Peter J SvenssonDepartment of Translational Medicine, Clinical Coagulation Research Unit, Skåne University Hospital, Malmö, Sweden.
Bengt GötrickDepartment of Orofacial medicine, Faculty of Odontology, Malmö University, Malmö, Sweden.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNo consistent approach to the management of direct oral anticoagulants (DOACs) during and after oral surgery has been established. Thus, DOACs may be unnecessarily discontinued, raising the potential risk of life-threatening thromboembolism. To address the inconsistency in this approach, our study assessed the risk of bleeding and other complications in patients who continue to use DOACs during and after simple and surgical tooth extractions.

methodsBetween May 2016 and December 2023, this prospective study recruited patients aged 18 years or older who were receiving a DOAC or warfarin and were in need of simple or surgical extractions of one or more teeth. Local haemostatic agents were being used to control bleeding. Patients were instructed to manage minor postoperative bleeding at home by biting down on gauze soaked in tranexamic acid for at least 30 min. After surgery, all patients were followed for 7 days. The chi-squared test compared dichotomous variables; the two-sample t-test, continuous variables; logistic regressions, dichotomous outcomes; and linear regressions, continuous outcomes.

resultsIn all, 354 teeth were extracted from 160 patients receiving DOACs and 56 patients receiving warfarin. The incidence of any type of postoperative bleeding was 27% in patients receiving DOACs and 37% in those receiving warfarin (OR 0.66, 95% CI: 0.28-1.57; p = 0.35). Most patients were able to manage any bleeding at home themselves. Clinically relevant bleeding necessitating prompt evaluation or a secondary surgical intervention by a dentist or healthcare professional occurred in 3% of patients receiving DOACs and 11% of patients receiving warfarin (OR 0.30, 95% CI: 0.08-1.06; p = 0.06). No reports of major bleeding requiring hospitalization or blood transfusion were found. Perioperative bleeding volume was comparable between the two groups.

conclusionsPatients receiving DOACs without interruption during surgery may have a lower risk of bleeding than those on warfarin. Patients may safely continue to use DOACs during and after simple and surgical extractions. This eliminates the potentially higher risk of serious thromboembolic events that are associated with a pause in anticoagulant therapy. CLINICAL

trial registrationClinicalTrials.gov (ID: NCT04662515). Retrospectively registered 4 December 2020.

Indexed as

AnticoagulantsPostoperative HemorrhageTooth ExtractionAdministration, OralAdultAgedAged, 80 and overFemaleHumansMaleMiddle AgedProspective StudiesWarfarinAnticoagulantsWarfarinAnticoagulantsDirect oral anticoagulantsFactor Xa inhibitorsOral haemorrhageOral surgical proceduresWarfarin

Identifiers

PMID40221663
PMCPMC11993950

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.