Direct oral anticoagulants and oral procedures: an integrative review
DOI:
https://doi.org/10.62741/ahrj.v3iSuppl.%202.226Keywords:
direct oral anticoagulants, oral surgical procedures, anticoagulants, blood coagulation disorders, bleedingAbstract
Introduction: Direct oral anticoagulants (DOACs) were introduced as alternatives to vitamin K antagonists for atrial fibrillation and venous thromboembolism. These drugs offer advantages: no need for routine monitoring, fewer side effects, and fewer drug interactions. However, no universally accepted guidelines exist for the dental management of patients receiving DOAC therapy
Objectives: The objective was to assess hemorrhagic risk in patients receiving DOACs during oral surgical procedures, compared with patients who interrupted therapy, received other anticoagulants, or had no coagulation disorders.
Methodology: This integrative review followed the Joanna Briggs Institute (JBI) Reviewer’s Manual and PRISMA-ScR guidelines. The protocol was registered on the Open Science Framework (DOI: 10.17605/OSF.IO/NPVYS). A literature search was conducted on March 22, 2025, in PubMed, ScienceDirect, and Scopus using PICO-based keywords related to DOACs, oral surgery, anticoagulation, coagulation disorders, and bleeding. English-language studies published between 2020–2025 were included. Methodological quality was assessed using the JBI checklist.
Results: The analysis of the included studies showed that bleeding in patients continuing DOAC therapy was generally mild, manageable with local hemostatic measures, and not higher than in other groups. No increase in severe bleeding was reported compared with therapy interruption or other anticoagulants. Discontinuation should be avoided due to thromboembolic risk.
Conclusion: Based on the available evidence, therapeutic continuity appears to be a safe strategy that prevents thromboembolic events associated with therapy interruption while ensuring safety in low- to moderate-risk surgical procedures.
Regarding high hemorrhagic-risk surgical procedures, the results suggest an individualized and multidisciplinary approach.
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