Managing patients taking edoxaban in dentistry.

A Curto,J Sanchez,D Curto

doi:10.4317/jced.53431

Abstract

BackgroundAnticoagulation 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 MethodsThis 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.ResultsThe 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.ConclusionsTheir 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.

Highlights

There are a large number of patients being treated with oral anticoagulants and antiplatelet drugs
The results proved that the efficacy of warfarin for the prevention of stroke and systemic embolism was noninferior to warfarin, and that the administration of edoxaban is associated with less morbidity [4]
In terms of International Normalized Ratio (INR) control, both for the risk of stroke and systemic embolism, and for that of major bleeding, the results were consistent for both doses of edoxaban, regardless of time in the therapeutic range (> 66.4% o ≤ 66.4%), there was a trend in favour of the high dose of edoxaban for lower risk of major bleeding in patients with poor INR control [5]

Summary

Introduction

There are a large number of patients being treated with oral anticoagulants and antiplatelet drugs. Vitamin K antagonist oral anticoagulants have a narrow therapeutic window, requiring regular International Normalized Ratio (INR) monitoring, and they have several drug-drug and drug-food interactions. These disadvantages compromise patients’ quality of life [2]. The different cost-effectiveness studies on new oral anticoagulants (edoxaban, dabigatran, rivaroxaban and apixaban) conducted in several countries are fairly consistent, showing that the administration of these drugs seems the best option for patients at increased risk for thromboembolic or bleeding complications and those with poor anticoagulation control with vitamin K antagonists [7]. There is a need for further clinical studies in order to establish more evidence-based guidelines for dental patients requiring edoxaban

Objectives

Methods

Conclusion