Dental Complications in Antithrombotic Patients: Evidence From a Nationwide Cohort and a Single-Institution Dataset

Abstract

Introduction and aims: This study aimed to evaluate the incidence and risk factors of postoperative bleeding and systemic complications occurring following dental procedures in patients undergoing antithrombotic therapy, using a nationwide cohort and single-institution clinical data. Methods: This retrospective cohort study analysed data from the (1) National Health Insurance Service-National Sample Cohort, representing 2.2% of the Korean population and (2) Severance Clinical Research Analysis Portal 2.0 at Yonsei University Dental Hospital. The study included adults aged >= 30 years who were diagnosed with cardiovascular disease and received dental treatment from 2015 to 2019. Results: Among 714,397 dental treatment cases in the National Health Insurance Service -National Sample Cohort, systemic bleeding and thromboembolic complications requiring hospitalization or resulting in death occurred in 0.30% and 0.06% of cases following dental treatment. In the single-institution dataset (n = 1,878), postoperative bleeding occurred in 2.18% of cases. Hypertension and diabetes mellitus were associated with systemic bleeding. Patients who received thrombolysis had a higher risk of thromboembolic complications, and vitamin K antagonists with heparin bridging were significantly associated with postoperative bleeding. Tooth extraction and implant surgery with bone grafting were associated with higher risks of postoperative bleeding, but implant placement without bone grafting was not significantly associated. Conclusion: VKAs with heparin bridging and implant surgery with bone grafting were associated with higher risks of postoperative bleeding and systemic complications. In contrast, the relatively low bleeding risk with single antiplatelet therapy and implant placement alone that dental procedures may be performed with an acceptable safety profile in Clinical relevance: This study provides real-world evidence on dental and systemic complications following dental procedures in patients receiving antithrombotic therapy. Procedural invasiveness, antithrombotic management, and patient comorbidities were relevant factors for complication risk and may support risk stratification and procedural planning in dental practice. (c) 2026 The Authors. Published by Elsevier Inc. on behalf of FDI World Dental Federation.