Novel Oral Anticoagulants: Comparative Pharmacology and Dental Implications

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The increase in life expectancy, and the prevalence of chronic diseases, including heart disorders and cerebrovascular events, has resulted in a growing number of patients on anticoagulant therapy coming for dental surgeries. Anticoagulant therapy is typically the goal for treatment and prevention of thromboembolic diseases . Interest in the development of new anticoagulation medications is growing because of the limitations of parentally administered heparin, the various drug interactions and monitoring concerns associated with vitamin K antagonists such as warfarin . During the last few years, a series of novel targeted anticoagulants have been developed and approved for treatment of various conditions. These include oral direct factor Xa inhibitors (Rivaroxaban, Apixaban and Edoxaban) and direct thrombin inhibitor (Dabigatran).

Before proceeding for surgery, dentists have to assess the thromboembolic risk related to the disease, and bleeding risks related to surgery. The treatments for when there is a risk of bleeding include the use of injectable anesthetics, tooth extractions, placing osseointegrated implants, periodontal surgery and periodontal curettage, minor oral surgery and root canal therapy. The knowledge of the correct protocol outpatient management is a prerequisite for starting treatment. To date, however, the management of these patients for minor oral surgery (such as for osseointegrated implants) is still a complex issue. A strong debate exists between the risk of uncontrolled bleeding in case of continuation of therapy or the possibility of thromboembolic complications in the case of discontinuation of the medication


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