Risk of bleeding after dentoalveolar surgery in patients taking anticoagulants

Br J Oral Maxillofac Surg. 2014 Mar;52(3):e15-9. doi: 10.1016/j.bjoms.2014.01.006. Epub 2014 Jan 30.


To avoid increasing the risk of thromboembolic events, it is recommended that treatment with anticoagulants should be continued during dentoalveolar operations. We have evaluated the incidence of bleeding after dentoalveolar operations in a prospective study of 206 patients, 103 who were, and 103 who were not, taking anticoagulants. Seventy-one were taking thrombocyte aggregation inhibitors and 32 vitamin K antagonists. Patients were treated according to guidelines developed at the Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. The operations studied included surgical extraction (when the surgeon had to incise the gingiva before extraction), non-surgical extraction, apicectomy, and placement of implants. Patients were given standard postoperative care and those taking vitamin K antagonists used tranexamic acid mouthwash postoperatively. No patient developed a severe bleed that required intervention. Seven patients (7%) taking anticoagulants developed mild postoperative bleeds. Patients taking vitamin K antagonists reported 3 episodes (9%) compared with 4 (6%) in the group taking thrombocyte aggregation inhibitors. Among patients not taking anticoagulants, two (2%) developed mild bleeding. The differences between the groups were not significant. All bleeding was controlled by the patients themselves with compression with gauze. We conclude that dentoalveolar surgery is safe in patients being treated with anticoagulants provided that the conditions described in the ACTA guidelines are met.

Keywords: Acenocoumarol; Apicectomy; Aspirin; Dental implantation; Haemorrhage; Tooth extraction.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use*
  • Antifibrinolytic Agents / therapeutic use
  • Apicoectomy / methods
  • Dental Implantation, Endosseous / methods
  • Female
  • Gingiva / surgery
  • Hemostatic Techniques
  • Humans
  • Male
  • Middle Aged
  • Oral Hemorrhage / etiology*
  • Oral Surgical Procedures / methods*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Postoperative Hemorrhage / etiology
  • Practice Guidelines as Topic
  • Prospective Studies
  • Risk Factors
  • Self Care
  • Tooth Extraction / methods
  • Tranexamic Acid / therapeutic use
  • Vitamin K / antagonists & inhibitors
  • Young Adult


  • Anticoagulants
  • Antifibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Vitamin K
  • Tranexamic Acid