Periprocedural Factor Xa Inhibitor Interruption and Resumption for Patients With Atrial Fibrillation Undergoing...

Area of Science:

• Cardiology
• Oral Surgery
• Pharmacology

Background:

• The PERIXa study demonstrated low bleeding and no thromboembolic events with a factor Xa (FXa) inhibitor interruption protocol for procedures of minimal to low bleeding risk.
• Dental procedures, however, exhibited the highest rate of all bleeding events in the original study.

Purpose of the Study:

• To analyze bleeding outcomes in atrial fibrillation (AF) patients undergoing dental procedures using a standardized FXa inhibitor interruption protocol.
• To evaluate the safety and efficacy of the PERIXa protocol across different dental procedure types, FXa inhibitor agents, and dosing regimens.

Main Methods:

• Inclusion of AF patients from the PERIXa study who underwent dental procedures with periprocedural direct oral anticoagulant (DOAC) interruption.
• Assessment of all-bleeding events (major, clinically relevant non-major, minor), thromboembolic events, and all-cause death within 30 days.
• Standardized questionnaires completed by dentists to report intraoperative bleeding severity.

Main Results:

• A total of 820 patients were analyzed, with an overall all-bleeding rate of 5.0% and a major bleeding rate of 0.2%.
• No thromboembolic events or deaths were reported within 30 days post-procedure.
• Bleeding risk did not significantly vary by dental procedure type, DOAC agent, or regimen, although implants and combined procedures showed numerically higher rates. Most dentists reported manageable bleeding.

Conclusions:

• The PERIXa protocol is safe and effective for managing anticoagulation in AF patients undergoing dental procedures.
• The findings support the protocol's applicability across diverse dental interventions and DOAC regimens, ensuring thromboembolic safety.