Implications of apixaban for dental treatments

Curto, Adrián; Albaladejo, Alberto

doi:10.4317/jced.53004

Cited by 6 publications

(5 citation statements)

References 32 publications

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“…In this group, the instructions to stop DOACs should be consulted with the specialist physician. The authors suggest that for low risk procedures discontinuation of dabigatran is not necessary and apixaban can be administered at a usual dose on the day, after the procedure ( 23 ). For medium and high risk procedures apixaban and dabigatran should be suspended for at least 24h and 48h respectively.…”

Section: Discussionmentioning

confidence: 99%

Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants?

Çalışkan

Tükel²,

Benlidayi³

et al. 2017

Med Oral

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BackgroundThe number of patients using direct oral anticoagulants (DOACs) instead of vitamin K antagonists (VKA) is increasing and there is limited data on the safety of tooth extractions in patients taking DOACs. The aim of this study was to compare the amount of bleeding (AOB) and postoperative complications after tooth extractions between patients taking VKAs and patients taking DOACs without altering the anticoaguation therapy.Material and MethodsThe study consisted of four groups: Direct thrombin inhibitor group, factor Xa inhibitor group, warfarin group and a control group. A single tooth was extracted in each patient and routine coagulation test values were recorded prior to extraction. AOB was measured for 20 minutes after tooth extraction. The patients were evaluated on 2nd and 7th days after extraction for bleeding. Status of bleeding was classified as no bleeding, mild bleeding controlled by gauze pads, moderate bleeding controlled by hemostatic agents and severe bleeding required hospitalization. Analysis of variance, chi square test and correlation analysis were used for statistical analysis of data.ResultsA total of 84 patients (48 male, 36 female) were included in this study. The mean age of patients was 57 (38-87) years. Mean AOB was 1388.6±913.0, 1909.29±1063.1, 3673±1415.4, 1593.33±672.5 mg for direct thrombin inhibitor, factor Xa inhibitor, warfarin and control groups respectively. Mean AOB was significantly higher for warfarin group, compared to other groups (p<0.05). The number of patients showing mild and moderate bleeding was significantly higher in warfarin group compared to other groups on the 2nd postextraction day (p=0.001). No bleeding was occurred in control group on 2nd and 7th postextraction days and no bleeding was occurred in direct thrombin inhibitor group on 7th postextraction day. The number of bleeding events among groups was not statistically significant on 7th postextraction day (p=0.251).ConclusionsPatients taking warfarin had more bleeding compared to patients taking direct oral anticoagulants after tooth extractions. In patients taking direct oral anticoagulants simple tooth extractions can be safely carried out without altering the anticaogulant regimen with the use of local hemostatic agents. Key words:Direct oral anticoagulants, dabigatran, rivaroxaban, apixaban, tooth extraction, oral surgery.

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Section: Discussionmentioning

confidence: 99%

Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants?

Çalışkan

Tükel²,

Benlidayi³

et al. 2017

Med Oral

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“…1 The characteristics of the evidence, including the types of participants (patients or populations), types of settings (e.g., countries) where the studies were performed, the intervention, and what the intervention was compared to. 2 The most important outcomes, including the intended benefits, possible harms and costs. 3 The estimated impact of the intervention on each outcome (preferably provided quantitatively).…”

Section: (2 Studies)mentioning

confidence: 99%

“…In oral surgery, the treatment of patients on antithrombotic drugs is one of the most frequently encountered challenges. These patients are at a varying risk of thromboembolism and intra- and post-operative bleeding, depending on the pharmacodynamic characteristics of the anticoagulant drugs and on the type of surgical intervention [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Today, thanks to the introduction of new oral anticoagulant drugs NOACs (non-vitamin-K oral anticoagulants) with their short half-life, more rapid onset and offset, fewer drug interactions, and the absence of any need for international normalized ratio (INR) assessment, this “bridging therapy” is no longer necessary [ 2 ]. The EHRA 2021 recommendations suggest that the patient characteristics (renal function, age, concomitant therapies and history of bleeding complications), the type of NOAC in use and the bleeding risk associated with the surgical procedure must be considered.…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness and Safety of Autologous Platelet Concentrates as Hemostatic Agents after Tooth Extraction in Patients on Anticoagulant Therapy: A Systematic Review of Randomized, Controlled Trials

Campana,

Aliberti,

Acerra

et al. 2023

JCM

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One of the common challenges in oral surgery is dealing with patients who are taking oral anticoagulant/antiaggregant drugs. Several local hemostatic agents have been proposed as an alternative to conventional suturing. Among these, autologous platelet concentrates (APCs) have been widely used to decrease the risk of hemorrhage after dental extraction. Nevertheless, there is a lack of consensus regarding the superiority of any one specific hemostatic agent over the others. This systematic review is aimed at evaluating the effectiveness of APCs as hemostatic agents after tooth extraction in patients on anticoagulant therapy. A literature search was conducted of articles published before March 2023 on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies on the use of APCs in patients undergoing dental extractions and being treated with anticoagulant drugs were included. Only randomized, controlled trials (RCTs) published up to March 2023 were included; the outcomes assessed were the time to hemostasis, the presence of post-operative bleeding and pain, and the effectiveness of wound healing. The risk of bias for each RCT was assessed by using the ‘risk of bias’ tool (RoB 1.0). The research revealed 6 RCTs. The findings indicated that patients on anticoagulant therapy who received APCs without discontinuing their medication experienced a decreased post-operative bleeding, a shorter hemostasis time, reduced pain, and accelerated wound healing. However, due to the high/unclear risk of bias of the studies included, no definitive conclusions can be drawn on the superiority of APCs as hemostatic agents over other similar products. Additional studies are required to validate these findings.

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“…It prevents the formation of thrombin and, hence, clot formation. Whether in its soluble form or bound to the prothrombinase complex, it attaches itself to the active site of factor Xa, consequently, interfering with its interaction with thrombin [32]. The drug is absorbed rapidly, and its maximum concentrations are reached at 3-4 hours after administration.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Non-Dental Drugs A Dentist Should Know: A Review

Saleem¹,

Ahmad²,

Karobari³

et al. 2020

Preprint

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More than 15,000 prescriptions and over the counter drugs are available according to the US Food and Drug Administration website. Moreover, several herbal medicines and dietary supplements are readily available to add to the list of possible drugs, which can potentially cause adverse drug interactions. These are a pressing concern for all as they can interfere with many dental procedures. Additionally, the number of geriatric patients seen in routine dental practice has increased over time. This implies that there are more patients with multiple diseases and health conditions like hypertension, diabetes, problems associated with the cardiovascular, renal and gastrointestinal systems, arthritis, osteoporosis, etc. All these require patients to be on certain medications. Furthermore, advancement in the dental field has led to more complex dental procedures (implants, grafts) being carried out in a general dental practice. These advanced and slightly more invasive treatments require the use of certain drugs before, during and after the treatment like local anesthetics, vasoconstrictors, anxiolytics, analgesics and antibiotics. All of these can possibly interact with medications a patient is already taking and can also interfere with the current dental treatment and create complications. This article aims to provide necessary information about commonly encountered systemic diseases and associated treating medications, their mechanism of action, possible complications and their management. The classes of drugs discussed include anti-platelet agents, vitamin K antagonists, novel oral anticoagulants, bisphosphonates, disease-modifying anti-rheumatic drugs and oral contraceptives.

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Implications of apixaban for dental treatments

Cited by 6 publications

References 32 publications

Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants?

Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants?

The Effectiveness and Safety of Autologous Platelet Concentrates as Hemostatic Agents after Tooth Extraction in Patients on Anticoagulant Therapy: A Systematic Review of Randomized, Controlled Trials

Non-Dental Drugs A Dentist Should Know: A Review

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