Oral Soft Tissue Biopsy in Patients Receiving Direct Oral Anticoagulants: A Prospective Cohort Study on Bleeding...

Direct oral anticoagulants (DOACs) are the first-line therapy for stroke prevention in non-valvular atrial fibrillation and venous thromboembolism. While evidence supports their continuation during routine dental procedures such as tooth extractions, data on oral soft tissue biopsies remain limited. The aim of this study was to evaluate bleeding rates in DOAC-treated patients undergoing oral biopsy without drug discontinuation, compared to anticoagulant-naive controls.

One hundred patients were enrolled and divided into two groups of 50: DOAC group and control group. Both groups underwent standardised excisional soft tissue biopsy. Bleeding was assessed intraoperatively, perioperatively, and daily from postoperative day 1 (T1) to day 7 (T7) via a patient-completed diary.

Intraoperative bleeding was significantly more frequent in the DOAC group (p < 0.05), as well as perioperative bleeding (p < 0.05). Postoperative bleeding was significantly higher in the DOAC group at T1 (22% vs. 6%, p < 0.05) and T2 (16% vs. 4%, p < 0.05), and moderate bleeding occurred exclusively in DOAC patients at T3 and T4 (4%, p < 0.05).

Oral soft tissue biopsy in DOAC-treated patients is associated with a higher risk of intra-, peri- and postoperative bleeding compared to controls. However, bleeding severity remains mild to moderate and appears manageable in an outpatient setting.

The study protocol was registered in a clinical trials database (Clinicaltrials.gov) with registration number NCT07520890.