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Matarese M, Cervino G, Fiorillo L, Stelitano C, Imbesi Bellantoni M, Meto A, Greco Lucchina A, Tornello FA, Runci Anastasi M, Rengo C. A cohort study on anticoagulant therapy risks in dental patients after multiple extractions. Minerva Dent Oral Sci 2021; 70:196-205. [PMID: 34842406 DOI: 10.23736/s2724-6329.21.04551-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Due to technology and pharmaceutical science and increasing life expectancy, the patient population is continuously aging. Patients requiring dental extractions often have systemic and/or chronic diseases and are undergoing polypharmacologic therapy. Oral surgeons often interface with patients who perform anticoagulant therapy. The main aim of this study was to clarify what the contraindications and short-/long-term complications may be. METHODS A sample of 298 patients (mean age 58 years) who required multiple surgical dental extractions has been taken in consideration. Patients were divided into groups and subgroups according to the anticoagulant drug therapy. RESULTS Long-term complications represented variable bleeding between groups from 8 hours to 7 days after surgery. The One-Way ANOVA Test was used to compare the results between groups. Patients treated with direct oral anticoagulants showed fewer intraoperative problems, but further studies and further collaboration between doctors, cardiologists and oral dentists/surgeons are certainly needed to manage these patients in a predictable manner. CONCLUSIONS This study showed that using direct oral anticoagulants drugs results in few intraoperative bleeding, less postoperative hemorrhagic complications, and an easier administration of the drugs respect vitamin K antagonists, with mild and manageable complications.
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Affiliation(s)
- Marco Matarese
- School of Dentistry, Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University Hospital of Messina, Messina, Italy
- IRCCS Centro Neurolesi "Bonino-Pulejo, " Messina, Italy
| | - Gabriele Cervino
- School of Dentistry, Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University Hospital of Messina, Messina, Italy
| | - Luca Fiorillo
- School of Dentistry, Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University Hospital of Messina, Messina, Italy -
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Carmelo Stelitano
- School of Dentistry, Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University Hospital of Messina, Messina, Italy
| | - Martina Imbesi Bellantoni
- School of Dentistry, Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University Hospital of Messina, Messina, Italy
| | - Aida Meto
- Department of Dental Therapy, Faculty of Dental Medicine, University of Medicine, Tirana, Albania
| | | | | | - Michele Runci Anastasi
- IRCCS Centro Neurolesi "Bonino-Pulejo, " Messina, Italy
- Department of Maxillo-Facial Surgery, Sapienza University, Rome, Italy
| | - Carlo Rengo
- Department of Prosthodontics and Dental Materials, University of Siena, Siena, Italy
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2
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Implant Placement in Patients under Treatment with Rivaroxaban: A Retrospective Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124607. [PMID: 32604907 PMCID: PMC7345116 DOI: 10.3390/ijerph17124607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
The management of patients under treatment with Direct Oral Anticoagulants (DOACs) has led clinicians to deal with two clinical issues, such as the hemorrhagic risk in case of non-interruption or the risk of thromboembolism in case of suspension of the treatment. The primary aim of this retrospective study was to evaluate the incidence of perioperative bleeding events and healing complications in patients who were under treatment with Rivaroxaban and who received dental implants and immediate prosthetic restoration. Patients treated with Rivaroxaban (Xarelto 20 mg daily) and who needed implant rehabilitation were selected. Four to six implants were placed in mandibular healed sites or fresh extraction sockets. All patients, in agreement with their physicians, interrupted the medication for 24 h and received implants and immediate restorations. Twelve patients and 57 implants were analyzed in the study. No major postoperative bleeding events were reported. Three patients (25%) presented slight immediate postoperative bleeding controlled with compression only. The implant and prosthetic survival rate were both 100% after 1 year. Within the limitations of this study, multiple implant placement with an immediate loading can be performed without any significant complication with a 24 h discontinuation of Rivaroxaban, in conjunction with the patient’s physician.
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3
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Berton F, Costantinides F, Rizzo R, Franco A, Contarin J, Stacchi C, Maglione M, Visintini E, Di Lenarda A, Di Lenarda R. Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study. Clin Oral Investig 2018; 23:3183-3192. [PMID: 30392079 DOI: 10.1007/s00784-018-2739-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/24/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this prospective comparative clinical study was to evaluate the effect of oral anticoagulants on peri- and post-operative bleeding during simple single tooth extractions, comparing patients in treatment with vitamin K antagonists (VKAs) and patients assuming direct oral anticoagulants (DOACs). MATERIALS AND METHODS Patients under oral anticoagulant therapy needing dental extraction were eligible for entering the study; patients were enrolled following inclusion and exclusion criteria and divided into VKAs and DOAC group according to the anticoagulation therapy. Included patients underwent a simple single dental extraction with elevators and forceps with a maximum surgical time of 15 minutes, without anticoagulation therapy discontinuation. All participants were assessed pre-operatively, during surgery, 30 min minutes and 7 days after surgery. Biological complications were registered and post-extraction bleeding was clinically defined according to Iwabuchi classification. Parametric and non-parametric tests were used to evaluate the variables between the groups. RESULTS Sixty-five patients per group were enrolled and 130 teeth were extracted. The two groups were comparable for pre-, peri-, and post-operative variables. Only 1 patient of DOAC group and 2 patients for VKA group needed medical evaluation for post-extractive bleeding. No statistically significant difference resulted in post-operative bleeding events between the groups (p = 0.425). CONCLUSIONS DOAC and VKA patients showed the same incidence of bleeding complications after simple single tooth extraction. Bleeding events were not statistically significant and not clinically relevant. CLINICAL RELEVANCE Patients assuming DOACs can be treated similarly to patients in VKAs therapy with INR index between 2 and 3. Non-ceasing of DOAC therapy seems to be appropriate for simple single dental extractions.
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Affiliation(s)
- Federico Berton
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Fulvia Costantinides
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberto Rizzo
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Franco
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Jenny Contarin
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Claudio Stacchi
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Michele Maglione
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Erika Visintini
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberto Di Lenarda
- Maxillofacial and Dental Surgical Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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4
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Fortier K, Shroff D, Reebye UN. Review: An overview and analysis of novel oral anticoagulants and their dental implications. Gerodontology 2018; 35:78-86. [DOI: 10.1111/ger.12327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Kevin Fortier
- Boston University Henry M. Goldman School of Dental Medicine; Boston MA USA
| | | | - Uday N. Reebye
- Oral and Maxillofacial Surgeon with Triangle Implant Center; Durham NC USA
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5
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Stasko J, Stasko J, Janickova M, Mikuskova K, Malachovsky I, Gengelova P, Kasaj M, Smatanova M, Statelova D. Direct Oral Anticoagulant Drugs in Dental Clinical Practice. ACTA MEDICA MARTINIANA 2017. [DOI: 10.1515/acm-2017-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The direct oral anticoagulant drugs (DOAC) are generally safe and effective in several clinical settings including acute venous thromboembolic disease, prophylaxis in the postoperative setting, prevention of thromboembolism in patients with non-valvular atrial fibrillation, and in the management of acute coronary syndrome. The relatively short half-life, rapid onset of action, and predictable pharmacokinetics should simplify periprocedural use of the DOAC. The aim of this work is to propose and summarize periprocedural management of patients treated with the DOAC in dental practice and to inform about the principal specifications of this treatment.
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Affiliation(s)
- J. Stasko
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, University Hospital Martin, Department of Oral and Maxillofacial Surgery, University Hospital Martin, Bratislava , Slovakia
| | - J. Stasko
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, University Hospital Martin, Department of Hematology and Transfusiology, University Hospital Martin, Bratislava , Slovakia
| | - M. Janickova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, University Hospital Martin, Department of Oral and Maxillofacial Surgery, University Hospital Martin, Bratislava , Slovakia
| | - K. Mikuskova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, University Hospital Martin, Department of Oral and Maxillofacial Surgery, University Hospital Martin, Bratislava , Slovakia
| | - I. Malachovsky
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, University Hospital Martin, Department of Oral and Maxillofacial Surgery, University Hospital Martin, Bratislava , Slovakia
| | - P. Gengelova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, University Hospital Martin, Department of Oral and Maxillofacial Surgery, University Hospital Martin, Bratislava , Slovakia
| | - M. Kasaj
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, University Hospital Martin, Department of Oral and Maxillofacial Surgery, University Hospital Martin, Bratislava , Slovakia
| | - M. Smatanova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, University Hospital Martin, Department of Oral and Maxillofacial Surgery, University Hospital Martin, Bratislava , Slovakia
| | - D. Statelova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, University Hospital Martin, Department of Oral and Maxillofacial Surgery, University Hospital Martin, Bratislava , Slovakia
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Curto A, Curto D, Sanchez J. Managing patients taking edoxaban in dentistry. J Clin Exp Dent 2017; 9:e308-e311. [PMID: 28210454 PMCID: PMC5303336 DOI: 10.4317/jced.53431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/31/2016] [Indexed: 11/25/2022] Open
Abstract
Background Anticoagulation therapy is used in several conditions to prevent or treat thromboembolism. A new group of oral anticoagulants with clear advantages over classic dicoumarin oral anticoagulants (warfarin and acenocoumarol) has been developed in recent years. The Food and Drug Administration has approved edoxaban, dabigatran, rivaroxaban and apixaban. Their advantages include: predictable pharmacokinetics, drug interactions and limited food, rapid onset of action and short half-life. However, they lack a specific reversal agent. Material and Methods This paper examines the available evidence regarding rivaroxaban and sets out proposals for clinical guidance of dental practitioners treating these patients in primary dental care. A literature search was conducted through July 2016 for publications in PubMed and Cochrane Library using the keywords “edoxaban”, “dabigatran”, “rivaroxaban”, “apixaban”, “new oral anticoagulants”, “novel oral anticoagulants”, “bleeding” and “dental treatment” with the “and” boolean operator in the last 10 years. Results The number of patients taking edoxaban is increasing. There is no need for regular coagulation monitoring of patients on edoxaban therapy. For patients requiring minor oral surgery procedures, interruption of edoxaban is not generally necessary. Management of patients on anticoagulation therapy requires that dentists can accurately assess the patient prior to dental treatments. Conclusions Their increased use means that oral care clinicians should have a sound understanding of the mechanism of action, pharmacology, reversal strategies and management of bleeding in patients taking edoxaban. There is a need for further clinical studies in order to establish more evidence-based guidelines for dental patients requiring edoxaban. Key words:Edoxaban, dabigatran, rivaroxaban, apixaban, novel oral anticoagulants, bleeding.
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Affiliation(s)
- Adrian Curto
- Proffesor in Pediatric Dentistry. Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Daniel Curto
- Student in Medicine. University of Salamanca, Salamanca, Spain
| | - Jorge Sanchez
- Master in Oral Surgery. Alfonso X El Sabio University, Madrid, Spain
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7
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Curto A, Albaladejo A. Implications of apixaban for dental treatments. J Clin Exp Dent 2016; 8:e611-e614. [PMID: 27957279 PMCID: PMC5149100 DOI: 10.4317/jced.53004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/12/2016] [Indexed: 11/05/2022] Open
Abstract
Background Anticoagulation therapy is used in several conditions to prevent or treat thromboembolism. Recently, new oral anticoagulants have been introduced as alternatives to warfarin and acenocoumarol. In Europe, the European Medicines Agency has approved dabigatran, rivaroxaban and apixaban. Their advantages include: predictable pharmacokinetics, drug interactions and limited food, rapid onset of action and short half-life. However, they lack a specific reversal agent. Material and Methods A literature search was conducted through November 2015 for publications in the ISI Web of Knowledge, PubMed, Scopus and Cochrane Library using the keywords “apixaban”, “rivaroxaban”, “dabigatran”, “new oral anticoagulants”, “dental treatment” and “dental implications”. We included studies published in English and Spanish over the last 10 years. Results Apixaban has been recently introduced in the daily medical practices for the control of thromboembolism. The number of patients taking apixaban is increasing. Management of patients on anticoagulation therapy requires that dentists can accurately assess the patient prior to dental treatments. It is important for dentists to have a sound understanding of the mechanisms of action and management guidelines for patients taking new oral anticoagulants. Conclusions The dentist should consider carefully the management of patients on apixaban. This paper sets out a clinical guidance of dental practitioners treating these patients. There is a need for further clinical studies in order to establish more evidence-based guidelines for dental patients requiring apixaban. Key words:Apixaban, new oral anticoagulants, dental treatment.
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Affiliation(s)
- Adrian Curto
- Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Alberto Albaladejo
- Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
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8
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I nuovi anticoagulanti orali e la loro gestione nella pratica clinica odontoiatrica. DENTAL CADMOS 2016. [DOI: 10.1016/s0011-8524(16)30078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Thean D, Alberghini M. Anticoagulant therapy and its impact on dental patients: a review. Aust Dent J 2016; 61:149-56. [DOI: 10.1111/adj.12344] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 12/31/2022]
Affiliation(s)
- D Thean
- Private Practice; Gold Coast Queensland Australia
| | - M Alberghini
- Royal Perth Hospital; Perth Western Australia Australia
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10
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Johnston S. An evidence summary of the management of the care of patients taking novel oral antiplatelet drugs undergoing dental surgery. J Am Dent Assoc 2016; 147:271-7. [DOI: 10.1016/j.adaj.2015.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/02/2015] [Accepted: 11/09/2015] [Indexed: 02/02/2023]
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Green B, Mendes RA, Van der Valk R, Brennan PA. Novel anticoagulants - an update on the latest developments and management for clinicians treating patients on these drugs. J Oral Pathol Med 2016; 45:551-6. [PMID: 27028407 DOI: 10.1111/jop.12441] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/13/2022]
Abstract
There are several novel anticoagulant agents that are being increasingly used as an alternative to warfarin, with these drugs being reported to be at least as effective if not better. Their increased use means that oral care clinicians should have a sound understanding of the mechanism of action, pharmacology, reversal strategies and management of bleeding in patients taking these drugs. Surprisingly, there is little published in the current literature specific to professionals involved in oral health care. In this review, we provide an overview of these drugs and discuss the management of patients who need an oral procedure based on currently available literature and clinical trials.
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Affiliation(s)
- Ben Green
- Department of Gastroenterology, Torbay Hospital, Torquay, UK
| | - Rui Amaral Mendes
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ruben Van der Valk
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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12
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Costantinides F, Rizzo R, Pascazio L, Maglione M. Managing patients taking novel oral anticoagulants (NOAs) in dentistry: a discussion paper on clinical implications. BMC Oral Health 2016; 16:5. [PMID: 26822674 PMCID: PMC4731944 DOI: 10.1186/s12903-016-0170-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/25/2016] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this paper is to contribute to the discussion on how to approach patients taking new orally administered anticoagulants (NOAs) dabigatran etexilate (a direct thrombin inhibitor), rivaroxaban and apixaban (factor Xa inhibitors), before, during and after dental treatment in light of the more recent knowledges. Discussion In dentistry and oral surgery, the major concerns in treatment of patients taking direct thrombin inhibitors and factor Xa inhibitors is the risk of haemorrhage and the absence of a specific reversal agent. 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 taking NOAs. For patients requiring simple dental extraction or minor oral surgery procedures, interruption of NOA is not generally necessary, while an higher control of bleeding and discontinuation of the drug (at least 24 h) should be requested before invasive surgical procedures, depending on renal functionality. Summary The clinician has to consider that the number of patients taking NOAs is rapidly increasing. Since available data are not sufficient to establish an evidence-based dental management, the dentist must use caution and attention when treating patients taking dabigatran, rivaroxaban and apixaban.
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Affiliation(s)
- Fulvia Costantinides
- School of Specialization in Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Roberto Rizzo
- School of Specialization in Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Lorenzo Pascazio
- Unit of Geriatrics, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Michele Maglione
- School of Specialization in Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Morimoto Y, Yokoe C, Imai Y, Sugihara M, Futatsuki T. Tooth extraction in patients taking nonvitamin K antagonist oral anticoagulants. J Dent Sci 2015; 11:59-64. [PMID: 30894947 PMCID: PMC6395147 DOI: 10.1016/j.jds.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 08/28/2015] [Indexed: 01/26/2023] Open
Abstract
Background/purpose The nonvitamin K antagonist oral anticoagulants direct-thrombin inhibitor dabigatran and the Xa inhibitors rivaroxaban and apixaban are now being used clinically. The course of the patients on these anticoagulants who underwent tooth extraction was assessed. Materials and methods The medical charts of these patients were investigated. Tooth extraction was performed while maintaining conventional anticoagulant therapy. Results Twenty-three teeth were extracted in 19 patients, including two surgical extractions. Among the 19 patients, nine patients ingested rivaroxaban, six apixaban, and four dabigatran. One patient on rivaroxaban showed persistent postoperative bleeding following two surgical extractions. Mild oozing was observed in five patients (two on rivaroxaban and three on apixaban). There was no bleeding episode in the patients on dabigatran. Conclusion The patients on rivaroxaban with a prolonged prothrombin time value have a higher risk of bleeding, especially undergoing surgical extraction. Apixaban correlates to neither activated partial thromboplastin time nor prothrombin time values and the countermeasures should be employed based on the clinical findings.
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Affiliation(s)
- Yoshinari Morimoto
- Department of Anesthesiology, Graduate School of Dentistry, Kanagawa Dental University, Kanagawa, Japan
- Special Patient Oral Care Unit, Kyushu University Hospital, Fukuoka, Japan
- Corresponding author. Department of Anesthesiology, Graduate School of Dentistry, Kanagawa Dental University, 82, Inaoka-cho, Yokosuka, Kanagawa, 238-8580, Japan.
| | - Chizuko Yokoe
- Department of Anesthesiology, Graduate School of Dentistry, Kanagawa Dental University, Kanagawa, Japan
| | - Yuko Imai
- Special Patient Oral Care Unit, Kyushu University Hospital, Fukuoka, Japan
| | - Megumi Sugihara
- Special Patient Oral Care Unit, Kyushu University Hospital, Fukuoka, Japan
| | - Toshiko Futatsuki
- Special Patient Oral Care Unit, Kyushu University Hospital, Fukuoka, Japan
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Lopez-Galindo M, Bagán JV. Apixaban and oral implications. J Clin Exp Dent 2015; 7:e528-34. [PMID: 26535102 PMCID: PMC4628810 DOI: 10.4317/jced.52470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/09/2015] [Indexed: 01/09/2023] Open
Abstract
Background Thrombotic disorders remain a leading cause of death in the Western world, and in this regard a number of anticoagulation treatment have been used, including heparins, fondaparinux, vitamin K antagonists (warfarin, acenocoumarol), and new oral anticoagulants such as apixaban.
For years there has been great controversy regarding the use of anticoagulants in planning dental treatments that imply bleeding. The main concerns about using new oral anticoagulants in invasive dental procedures are bleeding due to the lack of an antidote, and the thrombotic risk of the disease for which anticoagulation was indicated in the first place. Material and Methods A literature search was conducted through May 2014 using the keyword “apixaban” for publications in the ISI Web of Knowledge. The search was extended to other databases (PubMed, Scopus and the Cochrane Library). Results Based on the results of the different studies, apixaban seems to be a good alternative to conventional anticoagulation and a reasonable treatment option, though its main and most common adverse effect is bleeding. Dose adjustment is needed in some patients, though regular laboratory monitoring is not required. The use of the drug in different patient populations will define its final indications and doses. Conclusions Regarding the use of apixaban in the dental setting, there is a compelling need for further clinical studies in order to establish more evidence-based guidelines for patients requiring antithrombotic treatment. Key words:Apixaban, dental treatment, dental implications.
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Affiliation(s)
- Monica Lopez-Galindo
- Associate Professor, PhD, Dentistry Department, European University of Valencia, Valencia, Spain
| | - Jose V Bagán
- Dentistry Department, University of Valencia, Valencia, Spain. Chairman of Oral Medicine, University of Valencia. Head of the Department of Stomatology and Maxillofacial Surgery,Valencia University General Hospital, Valencia, Spain
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