Objective: The effect of direct oral anticoagulants (DOACs) on the risk of bleeding after tooth extraction remains unclear. This study aimed to evaluate the incidence of post-extraction bleeding among patients who received DOAC and vitamin K antagonists (VKAs), such as warfarin. Design: This study was a retrospective cohort analysis. Incidence rates and propensity score matched regression models were used to compare the risks of bleeding after tooth extractions involving DOACs and VKAs. Setting: The study took place in a single university hospital in Japan. Participants: Between April 2013 and April 2015, 543 patients underwent a total of 1,196 simple tooth extractions. Primary outcome measure: The primary outcome measure was the occurrence of post-extraction bleeding, which was defined as bleeding that could not be stopped by biting down on gauze and required medical treatment between 30 minutes and 7 days after the extraction. Results: A total of 1,196 tooth extractions (634 procedures) in 541 patients fulfilled the study criteria, with 72 extractions (41 procedures) involving DOACs, 100 extractions (50 procedures) involving VKAs, and 1,024 extractions (543 procedures) involving no anticoagulants. The incidences of post-extraction bleeding per tooth for the DOAC, VKA, and no anticoagulant extractions were 10.4%, 12.0%, and 0.9%, respectively. The incidences of post-extraction bleeding per procedure for DOACs, VKAs, and no anticoagulants were 9.7%, 10.0%, and 1.1%, respectively. In comparison to the VKA extractions, the DOAC extractions did not significantly increase the risk of post-extraction bleeding (odds ratio: 0.69; 95% confidence intervals: 0.24–1.97; p=0.49). Conclusions: The risk of post-extraction bleeding was similar for DOAC and VKA extractions.