Warfarin and Newer Agents: What the Oral Surgeon Needs to Know.
The new direct oral anticoagulants-dabigatran etexilate, rivaroxaban, and apixaban- have predictable pharmacokinetic and pharmacodynamic profiles and are alternatives to warfarin. However, many surgeons are wary of these drugs, as there is limited evidence on how to manage bleeding in patients taking them, and only recently has a specific antidote been developed to reverse their anticoagulant effect. Management of the newer agents requires careful adherence to primary measures of bleeding care, knowledge of their mechanism of action, and familiarity with the unapproved and untested reversal strategies that may be required in patients with life-threatening bleeding.
Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Room BSB 453 MSC 507, 173 Ashley Avenue, Charleston, SC 29425, USA. Electronic address: steedma@musc.edu.
Martin B
MB
Steed
Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Room BSB 453 MSC 507, 173 Ashley Avenue, Charleston, SC 29425, USA.
Matthew T
MT
Swanson
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D000931:Antidotes; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects*; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects*; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D019647:Oral Surgical Procedures; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects*; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects*; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
D000925:Anticoagulants; D000931:Antidotes; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
Andexanet alfa; Apixaban; Dabigatran; Factor Xa inhibitors; Praxbind; Rivaroxaban; Warfarin