When new drugs that are likely to gain significant popularity appear on the market, particularly those associated with bleeding diathesis, it is important for dentists to become familiar with these drugs and to understand the best way to manage patients using them when they need dental interventions.
While most dentists are comfortable managing patients on Coumadin, they are probably just beginning to see patients who are taking the four newer oral anticoagulants (NOACs): Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixan) and Savaysa (edoxaban). These agents have been approved for use in anticoagulating patients with non-valvular atrial fibrillation (AF), Deep vein thrombosis (DVT), pulmonary embolism (PE) and for post-operative prevention of DVT after hip and knee surgery.
Much like for patients taking Coumadin (Warfarin), these drugs can be continued for simple dental procedures. In instances where complicated dental procedures are planned, it’s critical to consult with the patient’s physician to discuss the feasibility of temporarily withholding these drugs to avoid excessive bleeding.
To intelligently manage these patients in the dental setting, it’s important to understand the indications for NOACs, their mechanisms of action, their advantages and their disadvantages.