Risk of Bleeding After Oral Surgery in Patients Taking Direct-Acting Oral Anticoagulants: A Systematic Review and Meta-Analysis
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Abstract
Background: Currently, there is an increasing number of patients with underlying diseases who receive Direct Oral Anticoagulants (DOACs) to prevent thromboembolism. Bleeding is a common risk in this patient group. However, there is a lack of clear empirical evidence regarding the risk of bleeding following oral surgery. This study aims to compile research results and conduct a meta-analysis on the risk of bleeding after oral surgery in patients using Direct Oral Anticoagulants.
Methods: A systematic search was conducted for clinical trial research from PubMed and Google Scholar databases. The search was filtered for English or Thai articles published from 2015 to 2024. The included studies conducted on patients undergoing oral surgery under uninterrupted DOACs therapy and reporting bleeding outcomes. Data were pooled to calculate risk ratios (RR) with 95% confidence intervals (CI).
Results: Eight studies were included and analyed. Meta-analysis indicated a statistically significant higher bleeding risk in patients receiving oral anticoagulants than in control group (RR=5.90 (95% CI=3.30 - 10.55, p<0.001) The result is high homogeneity of data (I2=10.5%). Asymmetrical funnel plot was found (Begg's test p-value = 0.083, Egger's test p-value =0.046) This can be interpreted as no publication bias, but there is evidence of a small study effect on the overall results of the study. Subgroup analysis revealed that the risk ratio for post-treatment bleeding in the DOAC group was 5.09 (95% CI=2.69- 9.65, p<0.001), while for the warfarin group it was 7.46 (95% CI=3.16 – 17.58, p= p<0.001). The Risk ratio of post operative bleeding in DOAC patients was not significantly lower than in warfarin patients. (p=0.48)
Conclusion: Meta-analysis indicated a statistically significant higher bleeding risk in patients receiving oral anticoagulants than in the group that did not receive anticoagulants. However, there was no statistically significant difference in the risk of bleeding in the DOACs and the warfarin patients.
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