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Cited by 4Atrial Fibrillation Management and OutcomesVenous Thromboembolism Diagnosis and ManagementAntiplatelet Therapy and Cardiovascular Diseases

Risk of bleeding with dentoalveolar surgery in patients taking direct oral anticoagulants or vitamin K antagonists: A systematic review and meta-analysis

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Dou, Ke, Shi, Yue, Yang, Baoyi, Zhao, Zhiguo·2025·Japanese Dental Science Review
DOI 10.1016/j.jdsr.2025.08.002PMC PMC12358962
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Abstract

Objective The aim of the present study was to assess and compare the bleeding risks in patients undergoing dentoalveolar surgery who were on uninterrupted therapy with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Methods Electronic database searches were performed in PubMed, Embase, Web of Science, and CENTRAL through 28 September 2024, following PICOS criteria. Two reviewers independently performed literature screening, data extraction, and assessed the risk of bias. Data were pooled to estimate risk ratios (RR) with 95 % confidence intervals (CI) using a fixed-effects model. Between-study heterogeneity was assessed with the Q statistic and I 2 . Subgroup analyses were conducted according to study characteristics, while sensitivity analyses were used to pinpoint potential sources of heterogeneity and evaluate the reliability of the results. Results 29 studies enrolled a total of 29,212 patients. Meta-analysis demonstrated a reduced risk of bleeding in patients receiving DOACs compared to those treated with VKAs (RR = 0.79, 95 % CI: 0.68–0.92, I 2 = 0 %, P = 0.002). Subgroup analysis revealed a significantly reduced risk of bleeding with dabigatran compared to VKAs (RR = 0.40, 95 % CI: 0.23–0.67, I 2 = 0 %, P = 0.0006). However, no statistically significant differences were found between rivaroxaban (RR = 1.08, 95 % CI: 0.84–1.39, I² = 38 %, P = 0.54), apixaban (RR = 0.88, 95 % CI: 0.64–1.3, I² = 0 %, P = 0.46), edoxaban (RR = 0.70, 95 % CI: 0.45–1.11, I² = 60 %, P = 0.13) and VKAs. Combined analyses indicated an increased risk of bleeding with DOACs compared to controls (RR = 3.23, 95 % CI: 2.18–4.78, I 2 = 24 %, P < 0.0001), as well as increased bleeding risk with VKAs (RR = 3.35, 95 % CI: 2.31–4.85, I 2 = 0 %, P ＜ 0.0001). Conclusions Patients receiving DOACs or VKAs have an increased risk of bleeding during dentoalveolar surgery, but severe bleeding requiring hospitalization or causing irreversible damage is rare. Patients using DOACs appear to have a lower bleeding risk compared to those on VKAs. This difference is mainly observed in dabigatran etexilate, while it remains unclear in rivaroxaban, apixaban, and edoxaban. Current quality of evidence is very low, which should be interpreted with caution. Future studies with higher quality of evidence are required to strengthen the validity of these findings.

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  • Combining warfarin with antiplatelet agents amplifies the risk of hemorrhage several-fold.

    “combining warfarin (an anticoagulant) with antiplatelet agents amplifies the risk of hemorrhage several-fold [7,8]”

    From Comparing Artificial Intelligence (ChatGPT, Gemini, DeepSeek) and Oral Surgeons in Detecting Clinically Relevant Drug–Drug Interactions in Dental Therapy (2025) · cites this paper as [7]

    The Discussion reports that, in dentoalveolar surgery, concomitant antiplatelet therapy did not significantly increase bleeding risk among patients taking DOACs or VKAs. The Results report a roughly threefold increase for VKAs versus controls, but that comparison does not test the added effect of antiplatelet agents. (LLM, conf=0.90)

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Cited by

Sorted by citations

Authors
Dou, K., Shi, Y., Yang, B., & Zhao, Z.
Affiliations
  • Nanjing Drum Tower Hospital (CN)
  • Nantong University (CN)
  • China Medical University (CN)
Corresponding author
Zhao, Zhiguo
ORCID
Venue
Japanese Dental Science Review
Publisher
Elsevier BV
Published
2025-12
Volume
61
Pages
188-199
ISSN
1882-7616 (ISSN-L)
DOI
10.1016/j.jdsr.2025.08.002
PMC
PMC12358962
OpenAlex
W4413103420
Cited by
4
References
1
Citations by year
2026: 4
FWCI
0.73
Type
journal article
Language
en
Open access
Licence
Locations
  • Japanese Dental Science Review (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
Keywords
dentoalveolar surgery, bleeding risk, direct oral anticoagulants, vitamin K antagonists, dabigatran, rivaroxaban, apixaban, edoxaban, perioperative anticoagulation, oral anticoagulant reversal, tooth extraction, dental implants, anticoagulant reversal agents, bleeding complications

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