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Abstract

DENTAL EXTRACTIONS IN PATIENTS ON NOVEL ORAL ANTICOAGULANTS: A SYSTEMATIC REVIEW AND METAANALYSIS

Vesala, Lillis, Pangalidou, Ziakas, Nacopoulos*, Dabarakis

ABSTRACT

Background: Anticoagulation therapy is the “gold standard” in treating and preventing thromboembolic disease. The indications for its use include prophylaxis against and management of venous thromboembolism (prior thromboembolism, physically constrained patients, post-complex operation patients, etc.) as well as the prevention of embolic stroke (patients with non-valvular atrial fibrillation, prosthetic heart valves). Due to a great percentage of patients receiving anticoagulation therapy, it is of fundamental importance that dental practitioners are familiar with such patients and their medical condition and needs. Dental practitioners should be well informed in advance of any prescription medications their patient is on, such as antiplatelet therapy, as well as of any other concurrent use of drugs. Interruption of anticoagulants is not commonly recommended, because the catastrophic risk of embolism, following anticoagulant suspension prevails over the risk of increased bleeding from tooth removal to a considerable extent. Material and Methods: The study’s design provided for two patient groups: patients on Novel Oral Anticoagulants (NOACs) and patients on Vitamin K Antagonists (VKAs) that undergo simple dental extractions. The search technique encompassed navigation through and diligent exploration of electronic databases, supplemented by hand searches. Applying the advance search option, i.e. from 1990 up to 2019, we conducted a search in MEDLINE, improving the accessed articles via Ovid interface. Our key words were primarily oriented towards a composite based on MeSH terms and text words. Other advance search options included “Randomized Controlled Trials (RCTs)”, “cohort studies” and “case-control studies” reporting post-extraction bleeding complications definable according to the Bleeding Academic Research Consortium (BARC). All retrieved articles were written in English. Results: The search in the literature yielded 190 studies. After reviewing their title and summary, 82 of them were found to meet the inclusion criteria and, thus, their full text articles were reviewed. Of these, 77 studies were excluded from systematic research, as they would no longer fulfill our inclusion criteria. The systematic review and meta-analysis comprised 5 clinical trials in total. Using the Cochran's Q test, non-significant heterogeneity was established between the studies of meta-analysis (p = 0.77> 0.10). Moreover, the value of I2 statistic is 0.0%, thus confirming the lack of significant heterogeneity. The pooled risk ratio (RR) is 1.005 (0.98, 1.03); this demonstrates that the appearance of Type I haemorrhage bears no distinction between NOACs and VKAs, given the unit is contained in the 95% confidence interval. In addition, it is observed that the results of the random-effects model are identical to those of the fixed-effects model due to the lack of significant heterogeneity. Conclusions: Due to the large-scale administration of NOACs, it is highly significant and determining that dentists are well informed on and knowledgeable of such newer drugs and their mechanisms of action. Accessing whether to switch oral surgery patients from NOACs to other medications is an essential parameter requires the conduction of more clinical trials.

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