Direct oral anticoagulants and its implications in dentistry. A review of literature

Abstract

BackgroundFour novel direct oral anticoagulants (DOACs) named dabigatran, rivaroxaban, edoxaban and apixaban have been recently introduced to overcome some of the drawbacks of existing anticoagulants. They have less interactions and do not require routine monitoring. However, there is not enough scientific data about the protocol to apply in these patients on DOACs undergoing dental treatment. Thus is necessary to evaluate the potential bleeding risk of these drugs, the possibility of thromboembolic events occurring if they are withdrawn or the need to change to heparin previously.Material and MethodsA comprehensive search of the PubMed, Scopus and ISI Web of Science databases was conducted to identify studies that evaluated the relationship between direct oral anticoagulants and dental procedures. The quality of the reported information was assessed following the PRISMA statement.ResultsEleven studies that met the inclusion criteria were included in the review: 2 randomized clinical trials, 3 prospective studies, 3 retrospective studies, 2 case series and 1 case report.ConclusionsDOACs are safe drugs in terms of bleeding. The possible postoperative bleeding complications are manageable with conventional haemostasis measurements. The bridging approach with heparin does not seem to be recommended. Consensus among the professionals involved in the management of the patient is fundamental in invasive dental treatments and in complex patients. Key words:Oral anticoagulants, DOAC, NOAC, dabigatran, rivaroxaban, apixaban, edoxaban, bleeding, oral surgery.

Implant Placement in Patients under Treatment with Rivaroxaban: A Retrospective Clinical Study

“…Conversely, the majority of studies in the scientific literature has dogmatically reported the interruption or continuation of the DOACs, as if the choice was only determined by the bleeding risk assessment, instead of being based on a balance between hemorrhagic risks, in case of continuation, and thromboembolic risks, in case of interruption. The use of direct oral anti coagulants for the prevention of thromboembolic events has tremendously increased during the last few years [26], and many clinicians have to manage patients who are under treatment with such medications and who need oral surgery procedures. It can be assumed that patients under treatment with anticoagulants and in need of oral surgery procedures have a higher risk of bleeding events.…”

Bleeding Complications in Anticoagulated and/or Antiplatelet-Treated Patients at the Dental Office: A Retrospective Study

“…We find anticoagulants such as dabigatran, with renal elimination, contraindicated in severe renal impairment [ 1 , 4 ]. It presents a half-life of 12 to 17 h [ 5 , 7 ] and its peak concentration in plasma is reached 2–3 h after its administration [ 5 ]. It also presents an antidote: idarucizumab [ 4 , 8 ].…”

“…It also presents an antidote: idarucizumab [ 4 , 8 ]. On the other hand, rivaroxaban presents a plasma half-life of 7 to 13 h [ 5 ], reaching its maximum peak after 2–4 h [ 5 , 7 ]. Its antidote is andexanet alfa [ 8 ].…”

“…Its antidote is andexanet alfa [ 8 ]. Apixaban presents a half-life of 8 to 13 h, with its peak after 3–4 h after administration [ 7 ]. Andexanet alfa is also the antidote in charge of the reversion of this anticoagulant’s action [ 8 ].…”

“…Andexanet alfa is also the antidote in charge of the reversion of this anticoagulant’s action [ 8 ]. Lastly, we find edoxaban, found in plasma from 10 to 14 h [ 5 , 7 ] and reaching its plasmatic peak at 1.5 h [ 7 ].…”