title: Managing patients taking novel oral anticoagulants (NOAs) in dentistry: a discussion paper on clinical implications.
abstract: BACKGROUND
  The aim of this paper is to contribute to the discussion on how to approach patients taking new orally administered anticoagulants (NOAs) dabigatran etexilate (a direct thrombin inhibitor), rivaroxaban and apixaban (factor Xa inhibitors), before, during and after dental treatment in light of the more recent knowledges.
  
  
  CONCLUSIONS
  In dentistry and oral surgery, the major concerns in treatment of patients taking direct thrombin inhibitors and factor Xa inhibitors is the risk of haemorrhage and the absence of a specific reversal agent. The degree of renal function, the complexity of the surgical procedure and the patient's risk of bleeding due to other concomitant causes, are the most important factors to consider during surgical dental treatment of patients taking NOAs. For patients requiring simple dental extraction or minor oral surgery procedures, interruption of NOA is not generally necessary, while an higher control of bleeding and discontinuation of the drug (at least 24 h) should be requested before invasive surgical procedures, depending on renal functionality. The clinician has to consider that the number of patients taking NOAs is rapidly increasing. Since available data are not sufficient to establish an evidence-based dental management, the dentist must use caution and attention when treating patients taking dabigatran, rivaroxaban and apixaban.
authors.affiliation: School of Specialization in Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy. f.costantinides@fmc.units.it.
authors.forename: Fulvia
authors.initials: F
authors.lastname: Costantinides
authors.affiliation: School of Specialization in Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rizzo
authors.affiliation: Unit of Geriatrics, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pascazio
authors.affiliation: School of Specialization in Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Maglione
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D000069604:Dabigatran / Q000008:administration & dosage; D003729:Dental Care; D006801:Humans; D011720:Pyrazoles / Q000008:administration & dosage; D011728:Pyridones / Q000008:administration & dosage; D000069552:Rivaroxaban / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
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