Risk of Bleeding during Implant Surgery in Patients Taking Antithrombotics: A Systematic Review

Area of Science:

• Oral Surgery
• Hematology
• Pharmacology

Background:

• Antithrombotic medications (anticoagulants and antiplatelet agents) are frequently prescribed.
• Concerns exist regarding the risk of postoperative bleeding in patients undergoing oral surgery, particularly for dental implant placement, while on these medications.
• Evidence-based guidelines are needed to manage antithrombotic therapy during implant surgery.

Purpose of the Study:

• To systematically review and assess the risk of postoperative bleeding in individuals undergoing oral surgery for dental implant placement.
• To evaluate the safety of continuing antithrombotic treatment (anticoagulants and/or antiplatelet agents) during this surgical procedure.

Main Methods:

• A comprehensive literature search was conducted across major databases (PubMed, Web of Science, Scopus, EMBASE) up to August 2020.
• Included were prospective clinical studies comparing implant placement in patients on antithrombotics versus those not on these medications, with standardized bleeding assessment.
• Meta-analysis was employed to quantify the bleeding risk in antithrombotic-treated patients.

Main Results:

• Five studies (4 high-quality, 1 medium-quality) were included in the meta-analysis.
• The overall risk of bleeding during implant placement was not substantially higher in patients taking antithrombotics (Odds Ratio = 2.19; 95% CI: 0.88-5.44, p=0.09).
• The absolute risk of bleeding was found to be low.

Conclusions:

• Antithrombotic therapy does not significantly increase the risk of postoperative bleeding for dental implant placement surgery.
• Discontinuation or dose alteration of antithrombotic medications is generally not necessary for patients undergoing implant placement.
• Maintaining antithrombotic treatment ensures patient safety and avoids potential thrombotic complications.