ABC | Volume 111, Nº3, September 2018

Original Article Andrade et al Anticoagulation and dental procedure Arq Bras Cardiol. 2018; 111(3):394-399 Table 1 – Clinical characteristics of the patients studied according to the intervention group Variable Warfarin (n = 25) Dabigatran (n = 12) p Value Age (median, IQR) – years 67 (54.5-75.5) 71 (65.5-80) 0.360 Female sex - n (%) 12 (48) 7 (58.3) 0. 556 SBP (median, IQR) – mm Hg 120 (110-140) 130 (102.5-137.5) 0.810 DBP (median, IQR) – mm Hg 80 (70-85) 80 (62.5-80) 0.432 HR (median, IQR) – bpm 76 (62.5-88) 76.5 (67.5-90.3) 0.554 Weight (median, IQR) – kg 68 (56.5-78.5) 67.5 (60-75.3) 0.810 Height (median, IQR) – m 1.61 (1.49-1.69) 1.605 (1.52-1.70) 0.810 INR (median, IQR) 2.5 (2.2-2.97) - - Teeth extracted (median, IQR) 1 (1-1.5) 1 (1-1.75) 0.962 Black color (%) 10 (40) 06 (50) 0.565 Family income (up to 1 minimum wage) – n (%) 20 (80) 10 (83.3) 0.594 Educational level (incomplete secondary level) – n (%) 16 (64) 7 (58.3) 0.507 Arterial hypertension – n (%) 18 (72) 11 (91.7) 0.177 Diabetes mellitus 2 - n (%) 10 (40) 04 (33.3) 0.493 Heart failure – n (%) 07 (28) 03 (25) 0.588 Traumatic dental extraction - n (%) 05 (20) 03 (33.3) 0.311 IQR: interquartile range; bpm: beats/minute; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; INR: International Normalized Ratio. Continuous variables (expressed as median and 25th and 75th percentiles) were compared by use of Mann-Whitney U test. The categorical variables “sex” and “black skin color” were compared by use of Chi-square test. The other variables were compared by use of Fisher exact test (expected frequencies ≤ 5). cardiologist), who will assess the risk of bleeding versus the risk of thrombosis for each patient. For those on dabigatran for AF without a previous stroke, suspending the medicine 24 hours before the procedure is considered relatively safe; however, for patients with a recent history of deep venous thrombosis, pulmonary thromboembolism or embolic stroke, suspending the medicine might be risky. 21 The clinician should consider that the number of patients taking NOACs is rapidly increasing and that the conflicting findings of several studies have shown that no ideal management has been established for the use of those medicines in patients who need to undergo dental procedures with a high risk for significant bleeding. 22 More recent data have emphasized that there is no need to suspend dabigatran in dental extraction, and have suggested that, in cases involving the risk for major bleeding, the decision to temporarily interrupt the drug should be individualized and agreed with the attending physician. 23,24 Table 2 – Clinical outcomes of bleeding in the warfarin and dabigatran groups before and after dental extraction Outcome Warfarin Dabigatran p Value Bleeding time 1 (median, IQR) 300 (240-390) 300 (240-360) 0.597 Bleeding time 2 (median, IQR) 0 (0-60) 0 (0-60) 0.666 Bleeding scale (median, IQR) 1 (1-2) 1 (1-1) 0.124 Bleeding before dental extraction – n (%) 24 (96) 12 (100) 0.676 Bleeding during dental extraction – n (%) 25 (100) 12 (100) - Bleeding after 24 hours – n (%) 8 (32) 0 0.028** Bleeding after 48 hours – n (%) 5 (20) 0 0.122 Delayed bleeding – n (%) 5 (20) 0 0.122 Bleeding during suture removal – n (%) 8 (32) 2 (16.7) 0.285 Bleeding after suture removal – n (%) 0 0 - (**): p value < 0.05 (-): statistical data not available because either all or no patient had the outcome in the two groups. 397