title: Tutorial in oral antithrombotic therapy: biology and dental implications.
abstract: OBJECTIVE
  Recent developments of new direct oral anticoagulants that target specific clotting factors necessitate understanding of coagulation biology. The objective of this tutorial is to offer dental professionals a review of coagulation mechanisms and the pharmacodynamics of the conventional and new oral anticoagulants. Also, we summarized the dental implications of the conventional and new anticoagulants.
  
  
  METHODS
  We searched Medline using search terms "antithrombotic", "antihemostasis" or "anticoagulation" and combined them with the search results of "dental", "oral surgery" or "periodontal". We restricted the results to "human" and "English".
  
  
  RESULTS
  The early coagulation cascade, the new cell-based coagulation model, the pharmacokinetics and pharmacodynamics of conventional antithrombotics, and new oral anticoagulants were reviewed. The new direct factor Xa inhibitors and the direct thrombin inhibitor (s), called direct oral anticoagulants (DOAs) have rapid onset of action, fast elimination on cessation, and fewer drug-drug or drug-food interactions than warfarin. However, the lack of antidotes raises concerns that some dental procedures may trigger serious hemorrhagic events. Additionally, careful perioperative withdrawal and resumption protocols for the DOAs are reviewed, because DOAs' blood levels are dependent on renal function. Also, various reversal strategies in the event of excessive bleedings are summarized. Perioperative management of dental patients taking new DOAs and conventional oral anticoagulants are also discussed. However, the perioperative strategies for DOAs are yet to be validated in randomized trials.
authors.affiliation: General Dentistry, Boston University, Henry M Goldman School of Dental Medicine, Boston, MA 02118, USA.
authors.forename: Hamid-Reza
authors.initials: HR
authors.lastname: Fakhri
authors.forename: Sok-Ja
authors.initials: SJ
authors.lastname: Janket
authors.forename: Elizabeth-A
authors.initials: EA
authors.lastname: Jackson
authors.forename: Alison-E
authors.initials: AE
authors.lastname: Baird
authors.forename: Richard
authors.initials: R
authors.lastname: Dinnocenzo
authors.forename: Jukka-H
authors.initials: JH
authors.lastname: Meurman
mesh_terms: D000284:Administration, Oral; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D019647:Oral Surgical Procedures; D012307:Risk Factors
chemical_list: D005343:Fibrinolytic Agents