New oral anticoagulants and their implications for dental patients
Anticoagulation therapy is used in several conditions to prevent or treat thromboembolism. Over the last 40 years, warfarin has been the oral anticoagulant of choice and has been considered the mainstay of treatment. However, its use is limited by a narrow therapeutic index and complex pharmacodynamics, necessitating regular monitoring and dose adjustments.
Recently, two new oral anticoagulants – Dabigatran etexilate (a direct thrombin inhibitor) and Rivaroxiban (a factor Xa inhibitor) – have been approved for use in North America and Europe. Unlike warfarin, Dabigatran and Rivaroxiban are relatively small molecules that work as anticoagulants by targeting specific single steps of the coagulation cascade.Their advantages, relative to Warfarin, include: predictable pharmacokinetics; limited food and drug interactions; rapid onset of action; and, short half-life. They require no monitoring. However, they lack a specific reversal agent.
The number of patients taking Dabigatran and Rivaroxaban is increasing. Therefore, it is inevitable that dentists will be required to perform invasive procedures on this cohort of patients. This paper outlines the various properties of the new oral anticoagulants and the most recent guidelines regarding the management of these dental patients taking these medications.
Journal of the Irish Dental Association 2014; 60 (3): 137-143
John Edward O’Connell
MB, BDS, MRCS, FFD RCSI
Department of Surgery, Cork University Hospital
Leo FA Stassen
FRCS (Ed) FDS RCS MA FTCD FFSEM(UK) FFD RCSI
Consultant Oral and Maxillofacial Surgery
Corresponding author: John Edward O’Connell
Department of Surgery, Cork University Hospital, Wilton, Cork