Postoperative Bleeding After Dental Implant Surgery in Patients on Direct Oral Anticoagulants: A Retrospective Case-Control Study.

Background: Dental implants are popular among both healthy and medically complex patients. Patients prone to thromboembolic events receive anticoagulant treatment, like direct oral anticoagulants (DOACs). When those patients undergo dental implantation, the risk of bleeding is higher. Objectives: This study primarily aims to describe and analyze bleeding events following dental implantation. The secondary aim is to identify risk factors for bleeding events in patients receiving DOACs, and to suggest precautions. Methods: A case-control retrospective study was carried out on patients who underwent dental implant insertion in a single dental clinic. The experimental group comprised patients on DOACs, while the control group consisted of healthy patients without anticoagulant treatment. The study was submitted and approved by the Helsinki committee of the medical center (ASF-205-23). Results: Out of 100 patients initially screened for the study, 80 were included: 41 in the experimental group and 39 in the control group. A total of 11 patients presented with bleeding: 7 in the experimental group and 4 in the control group. A higher incidence of bleeding was observed in the experimental group (17%) compared with the control group (10%). The odds of bleeding in patients receiving DOACs were 1.8 times higher than for those not receiving anticoagulant therapy. Bleeding risk was also elevated among patients who underwent bone grafting procedures, with an odds ratio (OR) of 3.47, and among patients aged over 75 years, with an OR of 3.92. All bleeding events were successfully managed using local hemostasis. Conclusions: Despite the study's limitations, it can be concluded that surgeons should consider complex surgical intervention, but should be careful and aware of several risk factors and precautions regarding bleeding. Patients on DOACs with additional bone grafting and medically compromised patients over 75 years old should be monitored in the first postoperative days, and the postoperative guidelines should be refined to address the risks effectively.