title: Managing direct oral anticoagulants in patients undergoing dentoalveolar surgery.
abstract: Our objective was to describe our experience of managing a cohort of adult patients prescribed direct oral anticoagulants (DOACs) undergoing dentoalveolar procedures between November 2012 and May 2016. Prior to conducting a procedure a formal assessment was made of each patient's anticoagulation treatment. A specific plan was then formulated, balancing the risk of bleeding with the risk of thrombosis. Patients received a telephone consultation one week following treatment to assess any post-operative bleeding. Eighty-two patients underwent 111 oral surgical procedures, the majority of which were dental extractions. In the case of 35 (32%) procedures, advice was given to omit the DOAC, either before or after treatment. There was no bleeding following the majority of procedures. Persistent bleeding followed 15 (13.5%) procedures, of which 7 (6.3%) procedures required specific intervention. The majority of patients prescribed DOACs can undergo dentoalveolar procedures safely. Important considerations when planning treatment are: (i) when the patient usually takes their dose of DOAC, (ii) the time the procedure is performed and, (iii) when the DOAC is taken post-procedure. In our experience, if these factors are considered carefully, omission of DOAC doses is unlikely to be required for most patients.
authors.affiliation: Department of Haematological Medicine.|Department of Oral Surgery, King's College Hospital NHS Foundation Trust.
authors.forename: J P
authors.initials: JP
authors.lastname: Patel
authors.affiliation: Institute of Pharmaceutical Science, King's College London.
authors.forename: S A
authors.initials: SA
authors.lastname: Woolcombe
authors.affiliation: Department of Haematological Medicine.
authors.forename: R K
authors.initials: RK
authors.lastname: Patel
authors.affiliation: Institute of Pharmaceutical Science, King's College London.
authors.forename: O
authors.initials: O
authors.lastname: Obisesan
authors.affiliation: Department of Haematological Medicine.
authors.forename: L N
authors.initials: LN
authors.lastname: Roberts
authors.affiliation: Institute of Pharmaceutical Science, King's College London.
authors.forename: C
authors.initials: C
authors.lastname: Bryant
authors.affiliation: Department of Haematological Medicine.
authors.forename: R
authors.initials: R
authors.lastname: Arya
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000539:Alveolar Process / Q000601:surgery; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures; D012189:Retrospective Studies; D014081:Tooth Extraction; D055815:Young Adult
chemical_list: D000925:Anticoagulants