Platelet-rich fibrin ensures hemostasis after single-tooth removal under factor Xa inhibitors — a clinical prospective randomized split-mouth study

Abstract

Objectives: In this prospective, double-blinded, randomized split-mouth study, the local hemostatic effect of platelet-rich fibrin (PRF) inserted into the extraction socket in patients taking factor Xa (FXa) inhibitors (apixaban, rivaroxaban, edoxaban) was compared to a hemostatic gelatine sponge (GS) as the “therapeutic gold standard” without withdrawal of oral anticoagulant therapy. Materials and methods: Single-tooth extraction was conducted under local anesthesia in n = 21 patients using a split-mouth design (42 teeth). Using a double-blind approach, the extraction socket on one side of the jaw was filled with PRF and on the other with a GS. Bleeding was assessed immediately after surgery, in 30 min, 1 h, 1.5 h, and on follow-up appointments in 24 h and on the 7th day. Results: In 67% of cases, mild postoperative oozing could be stopped 30–90 min after tooth extraction via gauze pressure without any delayed bleeding. Concerning bleeding events, there was no difference among the PRF and GS groups and no significant difference among rivaroxaban, apixaban, and edoxaban (all p > 0.15). Conclusion: PRF and GS are reliable hemostatic methods in postextraction sockets of patients taking FXa inhibitors. Clinical relevance: Consequently, there is no need to discontinue FXa inhibitors because of a single-tooth removal, eliminating the risk of thrombus formation.