ArticleClinical oral investigations2025
Evaluation of postoperative bleeding risk after dental extractions in patients on antithrombotic medication: A comparison of machine learning and clinical experience.
Article in Clinical oral investigations, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThe aim of this study was to identify high-risk dental extractions in patients taking antiplatelet (AP) medication or anticoagulants (ACs) and to compare an experienced surgeon's decisions with machine learning (ML) algorithms. MATERIALS AND
methodsOur study included 2000 procedures, of which 1788 were conducted in patients under monotherapy with AP medication, vitamin K antagonists (VKAs), heparin, or direct oral anticoagulants (DOACs), 426 were performed under dual therapy, and 27 under triple therapy. Four algorithms, logistic regression (LR), eXtreme gradient boost (XGB), random forest (RF), and K-nearest neighbors (KNN), were trained with 80% (1600 procedures) of the derived data. Afterwards, an experienced oral surgeon and the algorithms were tested on the remaining 20% (400 procedures) of the data to evaluate the predictive power with respect to bleeding incidents.
resultsThe incidence of hemorrhagic events was low (4.35%). Dual anticoagulation significantly affected the risk of bleeding. Evaluating the results of the predictions, all four algorithms outperformed the surgeon in terms of balanced accuracy (LR: 58%; RF: 59%; XGB: 61%; KNN: 62%; surgeon: 53%).
conclusionsDecision-making based on various parameters influencing bleeding risk is complex, and surgeons tend to overestimate this risk. Both the algorithms and the surgeon had a share of false positive predictions; however, in a medical context, preventive overcaution does less damage than underestimation. CLINICAL RELEVANCE: Algorithms can provide an objective assessment of bleeding risk and help determine risk profiles, uncover variables with the highest predictive power, and serve as guidance on postoperative observation periods.
trial registrationThis study was approved by the Ethics Committee of the Medical Faculty of RWTH Aachen (Decision Number 24-353). This was a retrospective clinical study designed to analyze postoperative bleeding after dental extractions in patients under antithrombotic medication and to evaluate the prediction of bleeding events by different algorithms and human experience.
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