Dental implications of novel oral anticoagulants

I read with interest the article ‘Warfarin and Drug Interactions: Prescribing Vigilance’ by Hook J et al (Dent Update 2016; 43: 34–36) about warfarin and their drug interactions in dental management.¹

Anticoagulation with low molecular weight heparin and vitamin K antagonists is the current standard of care for venous thrombo-embolism treatment and prevention. For the past decades, warfarin has been considered the mainstay of treatment, but its use is limited by a narrow therapeutic index that necessitates regular monitoring of the international normalized ratio (INR) and adjustments to the dose accordingly. Its use is also limited by drug interactions. Novel oral anticoagulants (dabigatran, rivaroxaban and apixaban) represent a new era in anticoagulation therapy. These novel oral anticoagulants have been developed and come in two categories: activated factor X inhibitors (rivaroxaban and apixaban) and a direct thrombin inhibitor (dabigatran). These new drugs do not require the INR to be monitored.²

There is little published in the current literature specific to professionals involved in oral health care. The degree of renal function, the complexity of the surgical procedure and the patient's risk of bleeding due to other concomitant causes are the most important factors to consider during surgical dental treatment of patients.^3,4

As the number of patients taking these novel oral anticoagulants has been increasing, their use poses a number of challenges in dental management. The dentist must use caution and attention when treating patients taking dabigatran, rivaroxaban and apixaban. As healthcare professionals we should also be aware of how and when to report adverse drug reactions.