New anticoagulants

Kreuziger, Lisa Baumann; Morton, Colleen T.; Dries, David J.

doi:10.1097/ta.0b013e318265cf9e

Cited by 28 publications

(8 citation statements)

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“…Therefore, and depending on the type of operation, the existence of renal failure, and the risk of hemostatic alterations, the medication should be suspended for a number of days before the operation is carried out (33). Firriolo et al (10) and Little (15) recommend suspending the anticoagulant 24 hours before the operation, followed by reintroduction once hemostatic control has been achieved.…”

Section: Considerations In Dental Carementioning

confidence: 99%

“…- Major bleeding risk (multiple extractions > 3, surgery lasting more than 45 minutes, head and neck cancer surgery) ( 35 ): Operations of this kind can give rise to potentially life-threatening bleeding complications. Therefore, and depending on the type of operation, the existence of renal failure, and the risk of hemostatic alterations, the medication should be suspended for a number of days before the operation is carried out ( 33 ). Firriolo et al ( 10 ) and Little ( 15 ) recommend suspending the anticoagulant 24 hours before the operation, followed by reintroduction once hemostatic control has been achieved.…”

Section: Considerations In Dental Carementioning

confidence: 99%

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Alternative to oral dicoumarin anticoagulants: Considerations in dental care

Mingarro-de-León

Chaveli-López

2013

J Clin Exp Dent

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Introduction: For over 50 years, vitamin K antagonists such as warfarin (Aldocumar®) and acenocoumarol (Sintrom®) have been the gold standard for reducing the risk of cerebrovascular events. In the last 5 years alternative anticoagulants have been evaluated that act directly upon a concrete target within the coagulation cascade, thereby affording a more predictable anticoagulant effect. The present study offers an update on the new oral anticoagulants and reviews the implications referred to the dental care of patients administered these substances. Material and methods: An exhaustive PubMed-Medline and Cochrane Library search was made of the main alternatives to conventional oral anticoagulation, covering those studies published in English and Spanish over the last 10 years. Specialized textbooks and pharmaceutical catalogs were also consulted. A total of 184 articles were identified, of which 76 met the inclusion criteria. Results: The new oral anticoagulants dabigatran, rivaroxaban and apixaban are safe and effective, and offer a series of advantages, including rapid action, no need for constant monitoring, few drug and food interactions, and a broad therapeutic margin. These drugs are expensive, however, and some lack a specific antidote, while others must be administered twice a day. Regarding the dental treatment of patients receiving these drugs, suspension or modification of the background medication is not required when performing invasive dental procedures, except where indicated by the prescribing physician. Conclusions: The new oral anticoagulants do not pose significantly greater risks than conventional oral anticoagulants when providing invasive dental treatment, and their suspension is not strictly required in such situations. Key words:Dabigatran, rivaroxaban, apixaban, dental, hemostasis.

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Section: Considerations In Dental Carementioning

confidence: 99%

Section: Considerations In Dental Carementioning

confidence: 99%

Alternative to oral dicoumarin anticoagulants: Considerations in dental care

Mingarro-de-León

Chaveli-López

2013

J Clin Exp Dent

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“…In particular, fatal bleeds and intracranial hemorrhage were reduced relative to warfarin. Despite the lower risk of spontaneous bleeding, in trauma these oral anticoagulants have been associated with significant bleeding leading to serious adverse events [3,4]. …”

Section: Introductionmentioning

confidence: 99%

A mouse bleeding model to study oral anticoagulants

Monroe

Hoffman

2014

Thrombosis Research

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New oral anticoagulants to reduce the incidence of thrombosis have recently become available. When compared to the existing therapy, warfarin, these novel agents have similar efficacy with a reduced risk of spontaneous bleeding. However, these novel agents have been associated with significant, even fatal, bleeding following trauma. Reversal agents are being developed that bind and neutralize these oral anticoagulants. However, these are not yet available. Another strategy is to increase thrombin generation by administration of “bypassing” agents such as prothrombin complex concentrates or factor VIIa. Several animal models have been used to model the hemostatic defect induced by the thrombin inhibitor dabigatran. A rat tail injury model, a rabbit cuticle bleeding model, and a rabbit kidney laceration model have all been reported to show increased bleeding, but with supratherapeutic doses of dabigatran. A mouse tail transection model has been reported to reflect increased bleeding at peak therapeutic dabigatran levels. We found that the Whinna saphenous vein hemostasis model reliably reflects a hemostatic defect at therapeutic levels of dabigatran. This model can potentially reflect the effects of reversal or bypassing agents.

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“…56 There is no universal consensus about timing of discontinuation, but general recommendation is for discontinuation at least 24 hours before low-risk surgery (≈2-3 half-lives), and 2 to 4 days before high-risk surgery (≈5 half-lives) in patients with appropriate renal function (longer with renal impairment). [56][57][58] Similarly, timing of resumption of medications takes into account the same considerations of half-life, renal function, and bleeding risk, with general recommendation for resumption of medications 24 hours after low-risk surgery, and 48 to 72 hours after high-risk surgery (again, longer with renal impairment).…”

Section: Clinical Considerations Periprocedural Managementmentioning

confidence: 99%

Clinical Experience With Novel Oral Anticoagulants for Thromboprophylaxis After Elective Hip and Knee Arthroplasty

Messerschmidt

Friedman

2015

ATVB

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T otal hip arthroplasty (THA) and total knee arthroplasty TKA are among the most common orthopaedic procedures performed today. In 2010, the number of THA and TKA procedures performed in the United States was 332 000 and 719 000, respectively.1 These numbers are expected to grow to 572 000 and 3.48 million THA and TKA procedures by 2030. Although THA and TKA improve mobility and quality of life, these patients are among those at highest risk for venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). Without thromboprophylaxis, the incidence of proximal DVT is 18% to 36% after THA and 5% to 22% after TKA, and incidence of PE is 0.9 to 2.8% after THA and 1.5% to 10% after TKA. 3The 35-day baseline untreated risk for symptomatic VTE is estimated at 4.3% overall, and the incidence of fatal PE has been found to be as high as 2% after total joint arthroplasty. 3With increasing numbers of THA and TKA procedures, the number of VTE events is expected to rise.Aside from fatal PE, other significant long-term complications can arise from VTE events, including post-thrombotic syndrome, chronic pulmonary hypertension, and risk of recurrent VTE events. Post-thrombotic syndrome, which involves pain, swelling, and skin changes in the affected extremity, occurs in 23% to 60% of patients within 2 to 3 years of a episode of DVT, and can be severe in 10% of cases. 4 Approximately 3.8% of patients who sustain a PE are diagnosed with chronic thromboembolic pulmonary hypertension within 2 years.5 Interestingly, index VTE provoked by surgery carries a much lower relative risk of recurrent VTE in the first year after stopping anticoagulant therapy (about one third) than if attributed to other nonsurgical factors, although risk of recurrence is still present (≈1.0%).6,7 Furthermore, 10% of patients who experience a VTE event after THA or TKA are readmitted to the hospital within 3 months after the VTE event, resulting in an increasing economic burden. 8 The risk of VTE events after THA and TKA can be decreased significantly with the use of pharmacological thromboprophylaxis. Low-molecular-weight heparins (LMWHs), vitamin K antagonists (VKAs) such as warfarin, and fondaparinux have reduced the cumulative incidence of symptomatic VTE between 1.7% and 2.3% within 3 months of THA and TKA, respectively. 9 Important consideration must be given to the timing of most VTE events. The median length of hospital stay for THA or TKA outside the United States is 10 days, whereas in the United States it is 3 days for THA and 4 days for TKA, and getting shorter. 10 Results from the Global Orthopaedic Registry showed that the mean times to a symptomatic VTE event were 21.5 days for THA and 9.7 days for TKA, occurring after the median time to discharge in 75% of THA and 57% of the TKA patients.9 Thus, with the current trend toward shorter hospital stays, the majority of VTE events occur in the © 2015 American Heart Association, Inc. Abstract-Anticoagulant medications help to reduce the risk of thromboembol...

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New anticoagulants

Cited by 28 publications

References 50 publications

Alternative to oral dicoumarin anticoagulants: Considerations in dental care

Alternative to oral dicoumarin anticoagulants: Considerations in dental care

A mouse bleeding model to study oral anticoagulants

Clinical Experience With Novel Oral Anticoagulants for Thromboprophylaxis After Elective Hip and Knee Arthroplasty

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