Postoperative Bleeding Complications Associated With Dental Implant Placement in Patients Receiving Antithrombotic Therapy: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to quantify the risk and clinical management of postoperative bleeding complications associated with dental implant surgery in adults on antithrombotic therapy. Comprehensive searches of PubMed, Cochrane CENTRAL, Embase, and Google Scholar (2011-2025) identified 15 observational studies comprising 3,101 participants and ∼2,300 implant placements, involving regimens of vitamin K antagonists, direct oral anticoagulants, and antiplatelet agents. The eligible studies included prospective and retrospective cohorts, cross-sectional and case-control designs, and the risk of bias was assessed using the ROBINS-I tool. A primary random-effects meta-analysis was done on eight studies, and it revealed a significantly elevated risk of postoperative bleeding among antithrombotic therapy recipients versus controls (pooled risk ratio, RR = 4.47; 95% CI: 2.35-8.51; P < 0.00001), albeit with low-to-moderate statistical heterogeneity (I² = 28%). Sensitivity analysis of restricted to low risk-of-bias studies (n = 4) showed attenuation of the pooled effect, yielding a non-significant association (RR = 1.61; 95% CI: 0.93-2.79; P = 0.09; I² = 0%), suggesting that the larger effect in the primary analysis is driven mainly by a small number of moderate-to-serious risk studies enriched for warfarin-treated patients and more invasive, full-arch procedures. Individual study estimates demonstrated bleeding rates ranging from <1% to 27.5% depending on anticoagulant class and procedural complexity, with warfarin and highly invasive surgeries presenting the greatest risk. Importantly, all bleeding incidents were successfully managed with local hemostatic measures, and no life-threatening events were reported. While it is generally safe to continue antithrombotic agents when local protocols for dental implant placement are rigorously followed, individualized patient risk stratification is crucial. Future high-quality trials are needed to refine evidence-based guidelines and optimize perioperative management in this growing patient population.