This prospective study investigated the frequency and severity of bleeding during and after tooth extractions in patients taking direct oral anticoagulants (DOACs). Patients requiring at least one extraction were enrolled, with their DOAC therapy either continued or temporarily paused. Participants were grouped according to the number of teeth removed (≤3 or >3), the use of flap elevation, and whether osteotomy was performed. Bleeding was monitored during the procedure, at 20, 40, 60, and 80 minutes post-procedure, and daily for the first week. A total of 49 patients were included (rivaroxaban, n=17; apixaban, n=16; edoxaban, n=8; dabigatran, n=8), of whom 33 withheld DOACs before surgery. Extraction of more than three teeth, flap elevation, and osteotomy were associated with higher bleeding incidence (p < 0.05). Bleeding events were more frequent in patients on rivaroxaban and apixaban. Although DOAC therapy may increase the risk of bleeding across all perioperative phases, most events were minor and manageable. Temporarily stopping DOACs reduced bleeding during the procedure but had no significant effect on post-operative hemorrhage.
