Risk of bleeding with dentoalveolar surgery in patients taking direct oral anticoagulants or vitamin K antagonists: A systematic review and meta-analysis
Abstract
Objective The aim of the present study was to assess and compare the bleeding risks in patients undergoing dentoalveolar surgery who were on uninterrupted therapy with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Methods Electronic database searches were performed in PubMed, Embase, Web of Science, and CENTRAL through 28 September 2024, following PICOS criteria. Two reviewers independently performed literature screening, data extraction, and assessed the risk of bias. Data were pooled to estimate risk ratios (RR) with 95 % confidence intervals (CI) using a fixed-effects model. Between-study heterogeneity was assessed with the Q statistic and I2. Subgroup analyses were conducted according to study characteristics, while sensitivity analyses were used to pinpoint potential sources of heterogeneity and evaluate the reliability of the results. Results 29 studies enrolled a total of 29,212 patients. Meta-analysis demonstrated a reduced risk of bleeding in patients receiving DOACs compared to those treated with VKAs (RR = 0.79, 95 % CI: 0.68–0.92, I2 = 0 %, P = 0.002). Subgroup analysis revealed a significantly reduced risk of bleeding with dabigatran compared to VKAs (RR = 0.40, 95 % CI: 0.23–0.67, I2 = 0 %, P = 0.0006). However, no statistically significant differences were found between rivaroxaban (RR = 1.08, 95 % CI: 0.84–1.39, I² = 38 %, P = 0.54), apixaban (RR = 0.88, 95 % CI: 0.64–1.3, I² = 0 %, P = 0.46), edoxaban (RR = 0.70, 95 % CI: 0.45–1.11, I²…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 29,212 participants or records.
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