An evidence summary of the management of patients taking direct oral anticoagulants (DOACs) undergoing dental surgery

Dental note: Treating patients on new anticoagulant drugs

“…For example, perform root canal therapy instead of extraction. 2 Similarly, it would be preferable to delay invasive dental treatment if possible for a patient who is only being anticoagulated for a short time, for example following joint replacement surgery.…”

“…Recent reviews [2][3][4] have not identified any randomised controlled trials, case-control studies or systematic reviews of the new drugs in patients having dental procedures. There is no firm clinical evidence on which to base a decision to either continue or discontinue the drugs before invasive dental treatment.…”

Management of dental patients taking direct oral anticoagulants: Dabigatran

“…We show here, and most authors and guidelines agree, that for oral surgical procedures with low risk of postoperative bleeding, there is no need to stop dabigatran prior to surgery; however, for surgical procedures with high risk of bleeding, it is recommended to stop the drug 24 hr prior to surgery (Abayon et al., ; Breik et al., ; Davis et al., ; van Diermen et al., ; Elad et al., ; Firriolo & Hupp, ; Griffiths & Scully, ; Heidbuchel et al., ; Johnston, ; Kerr et al., ; Mauprivez et al., ; Nathwani and Wanis, , Apr; Patel et al., ; Romond et al., ; Scully & Robinson, ; Sime, ; Zeevi et al., ). Unfortunately, there is a lack of consistency in the definition of low‐risk and high‐risk procedures among different studies.…”

“…Evidence‐based data on the dental management of patients on DOACs are lacking. In the main, the available literature is derived from experts’ opinion, case reports, and small case series; unfortunately, data from systematic reviews, randomized clinical trials, cohort studies, or case–control studies are not currently available (Abayon, Kolokythas, Harrison, & Elad, ; Breik, Cheng, Sambrook, & Goss, ; Davis, Robertson, Shivakumar, & Lee, ; van Diermen, van der Waal, & Hoogstraten, ; Elad, Marshall, Meyerowitz, & Connolly, ; Firriolo & Hupp, ; Griffiths & Scully, ; Heidbuchel et al., ; Johnston, ; Kerr, Ogden, & Sime, ; Mauprivez et al., ; Nathwani and Wanis, ; NHS Tayside Integrated Dental Service, ; Patel et al., ; Romond, Miller, & Henry, ; Scottish Dental Clinical Effectiveness Pro‐gramme, ; Scully & Robinson, ; Sime, ; Zeevi et al., ).…”

Anticoagulantes orais diretos no tratamento do tromboembolismo venoso em pacientes com câncer

“…Additionally, studies with DOACs began around the year 2000 and so they are no longer considered new. 1 These drugs are being prescribed with increasing frequency to treat venous thromboembolism (VTE), because of factors such as oral administration in fixed doses, good bioavailability, half-lives varying from 8 to 15 hours, and no need for monitoring. 2 The proportion of renal clearance varies from drug to drug, at 25% for apixaban, 33% for rivaroxaban, 50% for edoxaban, and 80% for dabigatran.…”