Abstract
Purpose: Novel oral antiplatelet (NOAP) (prasugrel and ticagrelor) and direct oral anticoagulant drugs (DOAC) (dabigatran, rivaroxaban and apixaban) have emerged in the last decade. This study was undertaken to determine current approaches taken to the management of patients taking these agents in dental practice in a remote and rural setting. Methods: A small retrospective study was carried out in a small island population that identified patients taking one of the above drugs. All national health service and private dental records were examined to determine the type of treatment carried out and whether drug therapy, treatment plans or actual treatment were modified as a result of NOAP or DOAC therapy. In addition other outcomes such as referral to another service for advice or treatment and any adverse bleeding events were noted. Results: 156 dental encounters for 95 patients taking one of the drugs were identified. Significant events were identified in sixteen encounters and the management of patients taking each drug type differed significantly between cases but no patients returned with troublesome post-operative bleeding. Conclusions: The approaches taken by dental surgeons in Orkney in the management of the NOAPs and DOACs varied and this is likely to be a reflection of the limited literature available.
Highlights
Over the past decade a number of new drugs have emerged which pose a risk to patients undergoing invasive dental procedures
Warfarin, which has been the mainstay of anticoagulation therapy for decades, is being replaced with newer agents which differ in that they target a single factor within the coagulation cascade directly and reach a more predicable peak plasma concentration so can be taken at a fixed daily dose with no need for blood monitoring [5,6,7]
These drugs have been termed direct, target-specific or novel oral anticoagulants (DOAC, Target-specific Oral Anticoagulants (TSOAC) or NOAC respectively) but the International Society on Thrombosis and Haemostasis Scientific and Standardisation Committee have settled on DOAC as the preferred term [8]
Summary
Over the past decade a number of new drugs have emerged which pose a risk to patients undergoing invasive dental procedures. Warfarin, which has been the mainstay of anticoagulation therapy for decades, is being replaced with newer agents which differ in that they target a single factor within the coagulation cascade directly and reach a more predicable peak plasma concentration so can be taken at a fixed daily dose with no need for blood monitoring [5,6,7] These drugs have been termed direct, target-specific or novel oral anticoagulants (DOAC, TSOAC or NOAC respectively) but the International Society on Thrombosis and Haemostasis Scientific and Standardisation Committee have settled on DOAC as the preferred term [8]. The main disadvantages of these drugs are the lack of a reversal agent ( agents are currently under development [9,10,11]) and the difficulties in assessing the level of anticoagulation as traditional tests such as INR are not reliable [12,13,14,15]
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