title: Novel anticoagulants: general overview and practical considerations for dental practitioners.
abstract: Currently, 4 novel Direct Oral Anticoagulants (DOACs) were approved by the FDA. This review focuses on these agents and proposes a matrix for the general dentists to assess bleeding risk in dental management of patient on DOACs. The outline covers the pharmacology of DOACs (rivaroxaban, apixaban, edoxaban and dabigatran), bleeding complications, risk associated with discontinuation, monitoring/reversal, and implications for the dental practitioners. A total of 18 randomized controlled trials were identified with mixed results in regards to the risk for bleeding. Considering the pharmacology of DOACs and challenges in monitoring and reversing their effect, the dentist should consider carefully the management of patients on DOACs as it may differ from patients on conventional anticoagulants. Based on the type of dental procedure and the medical risk assessment, several general treatment approaches can be considered: continue DOACs, time dental treatment as late as possible after the last DOACs dose, discontinue DOACs for 24hrs, or discontinue DOACs for 48hrs. Based on the current reported dental literature, limited dental surgery may benefit from the first 2 conservative options. However, this needs to be proven in comparative clinical trials.
authors.affiliation: Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.|Wilmot Cancer Center, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Elad
authors.affiliation: Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Marshall
authors.affiliation: Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.|Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: C
authors.initials: C
authors.lastname: Meyerowitz
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Center, Rochester, NY, USA.
authors.forename: G
authors.initials: G
authors.lastname: Connolly
mesh_terms: D000925:Anticoagulants / Q000494:pharmacology* / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D016903:Drug Monitoring; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D019242:Oral Medicine / Q000379:methods; D053210:Pharmaceutical Preparations, Dental / Q000494:pharmacology*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D053210:Pharmaceutical Preparations, Dental
keywords: anticoagulant; bleeding; dental; direct; management; novel