The use of dental implants has steadily increased and in recent years the largest increase has been noted in patients aged between 65-74 years. This age group are also likely to be on long-term prescription of antiplatelet and oral anticoagulants as prophylaxis against thromboembolic events. Dental implant placement as a surgical procedure presents a risk of intraoperative or postoperative bleeding for patients on oral anticoagulant (OAC) or antiplatelet (AP) therapy.
The aim of this review was to assess the risk of bleeding after implant placement in patients on oral anticoagulant or antiplatelet therapy.
Searches were conducted in the PubMed, Embase and Cochrane CENTRAL databases with no restriction on language. Studies of implant placement in patients on oral anticoagulant (OAC) or antiplatelet (AP) therapy with a sample size of 10 or more patients reporting on post-operative bleeding were considered. Two reviewers independently selected studies and extracted data with quality being assessed using the Newcastle-Ottawa scale. Risk ratios (RR) and 95% confidence intervals (CI) were calculated with subgroup analysis for type of OA.
- 7 studies (5 prospective, 2 retrospective) were involving a total of 1,111 patients were included.
- Local haemostatic measures were used to control intraoperative bleeding. Most studies used suturing and pressure pack of tranexamic acid.
- The Newcastle–Ottawa scale score of the included studies ranged from 6 to 8.
- Meta-analysis (6 studies) showed no difference in risk of bleeding between patients on oral anticoagulants and controls RR = 1.81 (95%CI; 0.70 to 4.63)
- Sub-group analyses were conducted for type or oral anticoagulant – see table below
|Comparison||No. of studies||Risk ratio (95%CI)|
|VKAs vs control||4||3.42 (1.00 to 11.67)|
|DOACs vs control||3||1.67 (0.49 to 5.70)|
|APs vs OAC||3||0.08 (0.01 to 0.76)|
VKAs (K antagonists), DOACs (direct oral anticoagulants)
The authors concluded: –
Continuation of OAC therapy in patients undergoing implant surgery does not increase the risk of bleeding provided local haemostatic measures are used. The indirect comparison suggests bleeding tendency may be higher with VKAs as compared to DOAC.
The reviewers have searched 3 major databases with no language restrictions identifying only 7 studies. The 7 studies were observational with 5 of the 7 involving a control group. A total of 1,111 patients were included, 583 of which were controls and while the authors note the potential for variation in the application of local haemostatic measures the included studies only reported 43 bleeding episodes. In view of the small number included studies and low number of bleeding episodes the sub-group analyses should be interpreted very cautiously and the main finding cautiously. With an ageing population and an increase in dental implant placement additional high quality well reported studies are needed to better quantify the level of risk.
The review authors mention that no standardised guidelines exists although the Scottish Dental Clinical Effectiveness Programme (SDCEP) have only this year updated their guidance for the Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs which we summarised (Dental Elf – Mar 16th – 2022)
Zou L, Hua L. Risk of bleeding with dental implant surgery in patients on anticoagulant or antiplatelet drugs: a systematic review and meta-analysis. Acta Odontol Scand. 2022 Jun 28:1-7. doi: 10.1080/00016357.2022.2085324. Epub ahead of print. PMID: 35763663.
Dental Elf – Mar 16th – 2022