Advertisement

Odontology

, Volume 103, Issue 3, pp 258–263 | Cite as

Managing dentoalveolar surgical procedures in patients taking new oral anticoagulants

  • Stefano Sivolella
  • Marleen De BiagiEmail author
  • Giulia Brunello
  • Mario Berengo
  • Vittorio Pengo
Review Article

Abstract

The development of new orally administered anticoagulants, such as dabigatran, rivaroxaban, and apixaban, in the past few years has focused on avoiding some of the drawbacks associated with warfarin. This work aims to illustrate the main features of the most commonly used new oral anticoagulants, reviewing the current literature on the management of patients taking these drugs and needing oral and implant surgery, and discussing the currently proposed related guidelines.

Keywords

Dabigatran Rivaroxaban Apixaban Oral anticoagulants Oral surgery 

Notes

Conflict of interest

None of the participants in this study have any relationships that might be construed to give rise to potential conflicts of interest, nor any financial or personal relationships that might inappropriately influence (or bias) the study design and/or results. There is consequently no potential conflict of interest relating to individual authors’ commitments or financial support.

References

  1. 1.
    Firriolo FJ, Hupp WS. Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:431–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Little JW. New oral anticoagulants: will they replace warfarin? Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:575–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Nagarakanti R, Ellis CR. Dabigatran in clinical practice. Clin Ther. 2012;34:2051–60.CrossRefPubMedGoogle Scholar
  4. 4.
    Jaffer AK. Anticoagulation management strategies for patients on warfarin who need surgery. Cleve Clin J Med. 2006;73(Suppl 1):S100–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Michota F. Transitions of care in anticoagulated patients. J Multidiscip Healthc. 2013;6:215–28.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Scaglione F. New oral anticoagulants: comparative pharmacology with vitamin K antagonists. Clin Pharmacokinet. 2013;52:69–82.CrossRefPubMedGoogle Scholar
  7. 7.
    Pengo V. Laboratory tests during direct oral anticoagulant treatment? Yes. Intern Emerg Med. 2013;8:371–2.CrossRefPubMedGoogle Scholar
  8. 8.
    Weitz JI, Gross PL. New oral anticoagulants: which one should my patient use? Hematol Am Soc Hematol Educ Progr. 2012;2012:536–40.Google Scholar
  9. 9.
    Van de Werf F, Brueckmann M, Connolly SJ, Friedman J, Granger CB, Härtter S, Harper R, Kappetein AP, Lehr T, Mack MJ, Noack H, Eikelboom JW. A comparison of dabigatran etexilate with warfarin in patients with mechanical heart valves: the Randomized, phase II study to evaluate the safety and pharmacokinetics of oral dabigatran etexilate in patients after heart valve replacement (RE-ALIGN). Am Heart J. 2012;163(931–7):e1.PubMedGoogle Scholar
  10. 10.
    Davis C, Robertson C, Shivakumar S, Lee M. Implications of dabigatran, a direct thrombin inhibitor, for oral surgery practice. J Can Dent Assoc. 2013;79:d74.PubMedGoogle Scholar
  11. 11.
    Aditya S. Oral and parenteral anticoagulants: new kids on the block. J Postgrad Med. 2012;58:275–85.CrossRefPubMedGoogle Scholar
  12. 12.
    van Ryn J, Stangier J, Haertter S, Liesenfeld KH, Wienen W, Feuring M, Clemens A. Dabigatran etexilate—a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost. 2010;103:1116–27.CrossRefPubMedGoogle Scholar
  13. 13.
    Schiele F, van Ryn J, Canada K, Newsome C, Sepulveda E, Park J, Nar H, Litzenburger T. A specific antidote for dabigatran: functional and structural characterization. Blood. 2013;121:3554–62.CrossRefPubMedGoogle Scholar
  14. 14.
    Xarelto®: European medicines agency—EPAR—product information, 2013. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000944/WC500057108.pdf. Accessed 15 Aug 2013 (first published December 1, 2009). Accessed Sept 2014.
  15. 15.
    Xarelto®: European medicines agency—assessment report, 2013. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Assessment_Report_-_Variation/human/000944/WC500144718.pdf. Accessed Sept 2014.
  16. 16.
    Eliquis®: European medicines agency—EPAR—product information, 2013. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf. Accessed Sept 2014.
  17. 17.
    Eliquis®: European medicines agency—summary of opinion (post authorisation), 2012. http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion/human/002148/WC500132869.pdf. Accessed Sept 2014.
  18. 18.
    Eliquis®: FDA accepts for review ELIQUIS® (apixaban) supplemental new drug application for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and for the reduction in the risk of recurrent DVT and PE, 2013. http://news.bms.com/press-release/fda-accepts-review-eliquis-apixaban-supplemental-new-drug-application-treatment-deep-v. Accessed Sept 2014.
  19. 19.
    Pollack CV Jr. Managing bleeding in anticoagulated patients in the emergency care setting. J Emerg Med. 2013;45:467–77.CrossRefPubMedGoogle Scholar
  20. 20.
    Lu G, DeGuzman FR, Hollenbach SJ, Karbarz MJ, Abe K, Lee G, Luan P, Hutchaleelaha A, Inagaki M, Conley PB, Phillips DR, Sinha U. A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa. Nat Med. 2013;19:446–51.CrossRefPubMedGoogle Scholar
  21. 21.
    van Diermen DE, van der Waal I, Hoogstraten J. Management recommendations for invasive dental treatment in patients using oral antithrombotic medication, including novel oral anticoagulants. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:709–16.CrossRefPubMedGoogle Scholar
  22. 22.
    Richards D. Guidelines for the management of patients who are taking oral anticoagulants and who require dental surgery. Evid Based Dent. 2008;9:5–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R. American college of chest physicians. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e326S–50S.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood. 2012;120:2954–62.CrossRefPubMedGoogle Scholar
  25. 25.
    Baglin TP, Cousins D, Keeling DM, Perry DJ, Watson HG. Safety indicators for inpatient and outpatient oral anticoagulant care: recommendations from the British Committee for Standards in Haematology and National Patient Safety Agency. Br J Haematol. 2007;136:26–9.CrossRefGoogle Scholar
  26. 26.
    Feldens CA, Vitolo MR, Drachler ML. Guidelines for the management of patients who are taking oral anticoagulants and who require dental surgery. Community Dent Oral Epidemiol. 2007;35:215–23.CrossRefPubMedGoogle Scholar
  27. 27.
    Mingarro-de-León A, Chaveli-López B, Gavaldá-Esteve C. Dental management of patients receiving anticoagulant and/or antiplatelet treatment. J Clin Exp Dent. 2014;6:e155–61.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Gómez-Moreno G, Aguilar-Salvatierra A, Martín-Piedra MA, Guardia J, Calvo-Guirado JL, Cabrera M, López-Gallardo C, Castillo T. Dabigatran and rivaroxaban, new oral anticoagulants. New approaches in dentistry. J Clin Exp Dent. 2010;2:e14–8.Google Scholar
  29. 29.
    Palareti G, Ageno W, Ferrari A, Filippi A, Imberti D, Pengo V, Rubboli A, Toni D. Clinical management of rivaroxaban-treated patients. Expert Opin Pharmacother. 2013;14:655–67.CrossRefPubMedGoogle Scholar
  30. 30.
    Fakhri HR, Janket SJ, Jackson EA, Baird AE, Dinnocenzo R, Meurman JH. Tutorial in oral antithrombotic therapy: biology and dental implications. Med Oral Patol Oral Cir Bucal. 2013;18:e461–72.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Healey JS, Eikelboom J, Douketis J, Wallentin L, Oldgren J, Yang S, Themeles E, Heidbuchel H, Avezum A, Reilly P, Connolly SJ, Yusuf S, Ezekowitz M, RE-LY Investigators. Periprocedural bleeding and thromboembolic events with dabigatran compared with warfarin: results from the randomized evaluation of long-term anticoagulation therapy (RE-LY) randomized trial. Circulation. 2012;126:343–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Breik O, Cheng A, Sambrook PJ, Goss AN. Protocol in managing oral surgical patients taking dabigatran. Aust Dent J. 2014;59:296–301.CrossRefPubMedGoogle Scholar
  33. 33.
    Romond KK, Miller CS, Henry RG. Dental management considerations for a patient taking dabigatran etexilate: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:e191–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Turpie AG, Kreutz R, Llau J, Norrving B, Haas S. Management consensus guidance for the use of rivaroxaban—an oral, direct factor Xa inhibitor. Thromb Haemost. 2012;108:876–86.CrossRefPubMedGoogle Scholar
  35. 35.
    Weitz JI, Quinlan DJ, Eikelboom JW. Periprocedural management and approach to bleeding in patients taking dabigatran. Circulation. 2012;126:2428–32.CrossRefPubMedGoogle Scholar
  36. 36.
    Fellows SE, Rosini JM, Curtis JA, Volz EG. Hemorrhagic gastritis with dabigatran in a patient with renal insufficiency. J Emerg Med. 2013;44:e221–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Wychowski MK, Kouides PA. Dabigatran-induced gastrointestinal bleeding in an elderly patient with moderate renal impairment. Ann Pharmacother. 2012;46:e10.CrossRefPubMedGoogle Scholar
  38. 38.
    Harel Z, Sholzberg M, Shah PS, Pavenski K, Harel S, Wald R, Bell CM, Perl J. Comparisons between novel oral anticoagulants and vitamin K antagonists in patients with CKD. J Am Soc Nephrol. 2014;25:431–42.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© The Society of The Nippon Dental University 2015

Authors and Affiliations

  • Stefano Sivolella
    • 1
  • Marleen De Biagi
    • 1
    • 3
    Email author
  • Giulia Brunello
    • 1
  • Mario Berengo
    • 1
  • Vittorio Pengo
    • 2
  1. 1.Department of Neurosciences, Institute of Clinical DentistryUniversity of PadovaPaduaItaly
  2. 2.Department of Cardiac Thoracic and Vascular SciencesPadova University HospitalPaduaItaly
  3. 3.DDS, Resident, Institute of Clinical DentistryAzienda Ospedaliera, University of PadovaPaduaItaly

Personalised recommendations