Hemostatic Agents for the Management of Bleeding Risk Associated with Oral Anticoagulant Therapy Following Tooth Extraction: A Systematic Review

The occurrence of bleeding following dental extraction is a relatively common complication. A history of therapy with oral anticoagulants represents a major favoring factor, both in patients treated with vitamin K-antagonists (especially warfarin) and with direct oral anticoagulants (DOACs). Several local hemostatic measures can be applied to limit the bleeding risk in these patients. The aim of this systematic review is to evaluate what measures can be adopted to limit the bleeding risk following dental extractions in patients treated with oral anticoagulants. A literature search was performed, and 116 articles were retrieved. Titles and abstract analyses excluded 91 articles, and three more articles were excluded following full-text analysis. The systematic review was performed on 22 articles. Among the included articles, 20 studies reported on patients treated with warfarin, and two studies on patients treated with DOACs. The agents employed included local intra-alveolar agents, tranexamic acid, and PRF. The included studies were all at moderate/high risk of bias. Moreover, limited evidence is available on hemostasis in patients treated with DOACs. The available evidence hinders stating the superiority of one agent over the others. Further research is advised to increase the level of evidence of the application of hemostatic agents in patients treated with oral anticoagulants.