ABSTRACT
An increasing number of patients in our country use oral anticoagulants for the prophylaxis and treatment of thromboembolic events. The cornerstone of these groups of agents is warfarin, a vitamin K antagonist, which has been the single alternative used by oral route for several years. However, due to warfarin’s late onset and long lasting action and the intense interactions with food and drugs, newer oral anticoagulants have emerged in the market in recent years. Dabigatran, rivaroxaban and apixaban are the novel agents used in our country.
Those drugs should be regulated in the perioperative period when patients receiving oral anticoagulants are referred for dental interventions. The interruption of agents may result in lethal consequences of thromboembolic events, while continuing raises the risk of bleeding. This review outlines the various properties of the oral anticoagulants and the most recent recommendations and guidelines regarding the management of dental patients taking these medications.
Keywords:
Warfarin, dental aproach, novel, bleeding risk, thromboembolism, dabigatran, rivaroxaban, apixaban
Introduction
Oral anticoagulant agents are used for the treatment of arterial and venous thromboembolism (VTE) or prophylaxis. Patients using these agents frequently refer to clinics for dental interventions. Withdrawing oral anticoagulants during the perioperative period increases the risk of thromboembolism and maintenance of them is associated with the risk of bleeding. Dentists should consider the risk of thromboembolism and bleeding under the guidance of a cardiologist and choose the most appropriate option among discontinuation, continuation or bridging.
Heart valve prosthesis, atrial fibrillation (AF) and VTE/pulmonary embolism history are the most important risk factors for thromboembolism. Thrombophilia tendency and some systemic diseases also increase the risk of thromboembolism (Table 1).
The risk of bleeding (no risk of bleeding, low or high risk of bleeding) is also affected by factors such as hypertension, liver and kidney failure, old age, predisposition to bleeding, and other drugs and alcohol use that increase bleeding.
Conclusion
In conclusion, it is observed that there is no need to bridge with LMWH routinely in perioperative period in patients who are currently using oral anticoagulants and who will undergo dental intervention. In line with this data, we believe that a large number of dental interventions can be performed using local hemostatic precautions without stopping oral anticoagulants and warfarin.
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