Key Points
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Presents an overview on the use and pharmacology of anticoagulant medications.
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Explores the current evidence-based management of patients on novel oral anticoagulants during oral surgical treatments.
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Outlines recommendations for practice for the management of patients on novel oral anticoagulants in primary and secondary care settings.
Abstract
Background Haemostasis is crucial for the success of oral surgical treatment as bleeding problems can cause complications both pre- and post-operatively. Patients on anticoagulant drugs present a challenge due to their increased risk of bleeding.
Aims To review the evidence for the management of oral surgery patients on novel oral anticoagulant therapy.
Methods A literature review was conducted in May 2016 of free-text and MESH searches (keywords: apixaban, dabigatran, rivaroxaban and dental extractions) in the Cochrane Library, PubMed and CINAHL. Trial registers, professional bodies for guidelines and OpenGrey for unpublished literature were also searched. Studies were selected for appraisal after limits were applied (adult, human and English only studies) and inclusion/exclusion criteria imposed.
Results Five studies were identified for critical appraisal using the CASP tools. These were a combination of systematic reviews and case series. Two case series were excluded due to low quality evidence. Curtin et al., Davis et al. and Constantinides et al. together with guidelines from the Scottish Dental Clinical Effectiveness Programme, have highlighted a protocol in managing these patients in a dental surgical setting.
Conclusion Patients on novel anticoagulant therapy requiring dental surgery can be managed appropriately either without discontinuation of therapy or a delay in dose. For those patients at higher risks of postoperative bleeding complications, it is advised to liaise with the specialist physician.
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Nathwani, S., Wanis, C. Novel oral anticoagulants and exodontia: the evidence. Br Dent J 222, 623–628 (2017). https://doi.org/10.1038/sj.bdj.2017.364
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DOI: https://doi.org/10.1038/sj.bdj.2017.364
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