Anticoagulation Use prior to Common Dental Procedures: A Systematic Review

Table 3

Recommendations for specific dental procedures based on corresponding RCTs, CCTs, and/or expert opinion.

Dental procedure	Risk of bleeding	Number of RCTs and CCTs dealing with the procedure	Recommendation for VKA and NOAC use preprocedurally
Surgical teeth extraction	Low	RCTs: 4 [17, 27, 29, 30] + 1 [28]; CCTs: 2 [32, 35] + 2 [31, 34]	VKAs should be continued if INR is in therapeutic range [17, 27, 28, 30, 32, 34, 35] or <3 [29, 31]; Local hemostatic agents were judged essential in most studies [17, 28–30, 35]; NOACs: no RCTs or CCTs available yet; Expert opinion: continue NOACs with caution with local hemostatic agents
Implant surgery	Low [33]	RCTs: 1 [28]; CCTs: 1 [33]	VKAs: continue anticoagulation if INR is in therapeutic range [28, 33] with use of local hemostatic agents [28]; Continue anticoagulation with NOACs [33]
Excision of cystic formations	Low (Expert opinion)	RCTs: 1 [28]; CCTs: 0	VKAs must be continued if INR is in therapeutic range, with the use of local hemostatic agents [28]; NOACs: no RCTs or CCTs available yet; Expert opinion: continue NOACs with caution with local hemostatic agents
Biopsy	High [36]	RCTs: 0; CCTs: 1 [34]	VKAs must be continued if INR is in the therapeutic range. No local hemostatic agents are needed [34]; NOACs: no RCTs or CCTs available yet; Expert opinion: continue NOACs with caution with local hemostatic agents
Alveoloplasty	Moderate (Expert opinion)	RCTs: 0; CCTs: 1 [31]	VKAs must be continued if INR is less than 3. No local hemostatic agents are needed [31]; NOACs: no RCTs or CCTs available yet; Expert opinion: NOACs must be continued along with local hemostatic agents
Frenectomy	Moderate (Expert opinion)	RCTs: 0; CCTs: 1 [31]	VKAs must be continued if INR is less than 3. No local hemostatic agents are needed [31]; NOACs: no RCTs or CCTs available yet; Expert opinion: NOACs must be continued along with the use of local hemostatic agents
Periodontal surgery	High if raising a flap is needed [36]	RCTs: 0; CCTs: 0	Expert opinion: continue oral anticoagulation as scheduled if INR is within the therapeutic range (if VKAs), with the use of local hemostatic agents
Endodontic microsurgery (apicectomy)	High [37]	RCTs: 0; CCTs: 0	Expert opinion: continue anticoagulation with caution with local hemostatic measures

The corresponding RCTs or CCTs deal only with the unique procedure cited above. The corresponding RCTs or CCTs deal with multiple procedures, among which one has been cited. RCT  =  randomized controlled trial; CCT  =  controlled clinical trial; VKAs = vitamin K antagonists; NOACs = novel oral anticoagulants; OAT = oral anticoagulation therapy.