Implications of Dabigatran, a direct thrombin inhibitor, for oral surgery practice.
Direct thrombin inhibitors, specifically orally administered dabigatran etexilate, are emerging as alternatives to warfarin for anticoagulation in the management of atrial fibrillation and venous thromboembolism. The risk associated with bleeding events while taking dabigatran has been documented in multiple randomized controlled trials, but to date, no studies have focused on the risk of bleeding after dental extraction. Extraction of teeth is one of the most common surgical procedures and may cause significant bleeding, so a thorough understanding of the pharmacology of anticoagulant medications is required to prevent complications. With the increasing use of direct thrombin inhibitors, the safe management of patients taking these anticoagulants must be delineated. This review compares dabigatran and warfarin, especially in terms of their effects on dental and oral surgery practice, and examines best management of these patients in light of the existing literature.
Department of Oral and Maxillofacial Surgery, Capital Health & Dalhousie University, QEII Health Science Centre, VG site, Halifax, Nova Scotia, Canada. cmd@dal.ca
Clayton
C
Davis
Chad
C
Robertson
Sudeep
S
Shivakumar
Min
M
Lee
D000284:Administration, Oral; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D000069604:Dabigatran; D004347:Drug Interactions; D006801:Humans; D019934:International Normalized Ratio; D019106:Postoperative Hemorrhage / Q000209:etiology; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013515:Surgery, Oral; D014081:Tooth Extraction; D014859:Warfarin / Q000494:pharmacology / Q000627:therapeutic use; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
D000991:Antithrombins; D001562:Benzimidazoles; D011725:Pyridines; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran