Data from: Risks of post-extraction bleeding after receiving direct oral anticoagulants or warfarin: a retrospective cohort study

Objective: The effect of direct oral anticoagulants (DOACs) on the risk of bleeding after tooth extraction remains unclear. This study aimed to evaluate the incidence of post-extraction bleeding among patients who received DOAC and vitamin K antagonists (VKAs), such as warfarin.
Design: This study was a retrospective cohort analysis. Incidence rates and propensity score matched regression models were used to compare the risks of bleeding after tooth extractions involving DOACs and VKAs.
Setting: The study took place in a single university hospital in Japan.
Participants: Between April 2013 and April 2015, 543 patients underwent a total of 1,196 simple tooth extractions.
Primary outcome measure: The primary outcome measure was the occurrence of post-extraction bleeding, which was defined as bleeding that could not be stopped by biting down on gauze and required medical treatment between 30 minutes and 7 days after the extraction.
Results: A total of 1,196 tooth extractions (634 procedures) in 541 patients fulfilled the study criteria, with 72 extractions (41 procedures) involving DOACs, 100 extractions (50 procedures) involving VKAs, and 1,024 extractions (543 procedures) involving no anticoagulants. The incidences of post-extraction bleeding per tooth for the DOAC, VKA, and no anticoagulant extractions were 10.4%, 12.0%, and 0.9%, respectively. The incidences of post-extraction bleeding per procedure for DOACs, VKAs, and no anticoagulants were 9.7%, 10.0%, and 1.1%, respectively. In comparison to the VKA extractions, the DOAC extractions did not significantly increase the risk of post-extraction bleeding (odds ratio: 0.69; 95% confidence intervals: 0.24–1.97; p=0.49).
Conclusions: The risk of post-extraction bleeding was similar for DOAC and VKA extractions.

【研究目的】直接口服抗凝药（direct oral anticoagulants，DOACs）对拔牙后出血风险的影响目前尚未明确。本研究旨在评估接受DOAC与华法林（warfarin）等维生素K拮抗剂（vitamin K antagonists，VKAs）的患者群体中，拔牙后出血的发生率。
【研究设计】本研究为回顾性队列分析（retrospective cohort analysis）。研究采用发生率及倾向得分匹配回归模型（propensity score matched regression models），对比使用DOAC与VKAs的患者在拔牙后发生出血的风险。
【研究场景】本研究在日本的一所单中心大学附属医院开展。
【研究对象】2013年4月至2015年4月期间，共计543名患者接受了1196例单纯拔牙手术。
【主要结局指标】本研究的主要结局指标为拔牙后出血（post-extraction bleeding）事件的发生，定义为拔牙后30分钟至7天内，通过咬压纱布无法止血且需接受医疗干预的出血情况。
【研究结果】共计541名患者的1196例拔牙手术（共634次就诊操作）符合本研究纳入标准，其中使用DOACs的拔牙手术72例（对应41次就诊操作），使用VKAs的拔牙手术100例（对应50次就诊操作），未使用抗凝药物的拔牙手术1024例（对应543次就诊操作）。按单颗拔牙手术计算，DOAC组、VKA组及未使用抗凝药物组的拔牙后出血发生率分别为10.4%、12.0%及0.9%；按每次就诊操作计算，三组的出血发生率分别为9.7%、10.0%及1.1%。与VKA组相比，DOAC组患者拔牙后出血风险并无显著升高（比值比（odds ratio）：0.69；95%置信区间（confidence intervals）：0.24~1.97；P=0.49）。
【研究结论】使用DOAC与VKAs的患者，其拔牙后出血风险并无显著差异。