Novel Oral Anti-Coagulants (NOAC's)
& Oral Surgery
Dabigatran, Apixaban and Rivaroxaban are novel / new
oral anti-coagulants (NOACs) that are alternatives to the  
coumarins (e.g. warfarin) in selected groups of patients for
certain indications.

These medications are
Direct Thrombin Inhibitors
Dabigatran) & Factor Xa Inhibitors (Rivaroxaban &

These drugs are orally administered, have predictable
pharmacokinetics and dose response, do not require
monitoring & have an acceptable safety profile when used
appropriately, & so avoid many of the disadvantages &
possible complications of
warfarin and heparin.
Novel Oral Anti-Coagulants (NOAC's)
Coagulation monitoring is usually not required for rivaroxaban or dabigatran and
reliable tests are not available.

There are no evidence-based guidelines for the dental management of patients
receiving these agents. However, because of their predictable & stable
anticoagulant effects, comparable bleeding risks, & lower risk of drug interaction,
dental management may be safer and easier with these drugs.

However, more scientific evidence, time, and experience is needed.
NOAC's & the Clotting Pathway
Last Updated 10th March 2016
Useful Articles:

Thromb Haemost 2010.  Management of dental extraction in patients undergoing
anticoagulant treatment.

Oral Surgery Oral Medicine Oral Pathology Oral Radiol 2012.  Beyond Warfarin -
The New Generation of Oral Anticoagulants & Their Implications for the
Management of Dental Patients

BDJ 2013.  Letters to the Editor.  New Anticoagulants

BDJ 2013.  The Changing Face of Oral Anticoagulants

BDJ 2013.  Anticoagulant Update

J Blood Disorders Transf 2013.  Anti-Thrombotic Therapy.  Implications for
Invasive Outpatient Procedures in Dentistry

J Can Dent Assoc 2013.  Implications of Dabigatran, a Direct Thrombin Inhibitor,
for Oral Surgery Practice

J Clin Exp Dent 2013.  Alternative to oral coumarin anticoagulants.  Considerations
in dental care.

NHS Tayside Integrated Dental Service Local Guidance 2013.  Dental
Management of Patients Taking Anticoagulant Drugs Outside a General Hospital

Aust Dent J 2014.  Protocol in Managing Oral Surgical Patients taking Dabigatran

BDJ 2014. Pharmacology. A New Bleeding Issue

BDJ 2014.  Dabigatran (Pradaxa) - Surgeon's Friend or Foe

J Irish Dent Assoc 2014.  New Oral Anticoagulants & their Implications for Dental

Public Health Wales 2014.  Dental Public Health Team Information on New Oral
Anticoagulants for Primary Care General Dental Practitioners

Dental Update 2015.  A New Generation of Antiplatelet & Anticoagulant
Medications & the Implications for the Dental Surgeon

Scottish Dental Clinical effectiveness Programme 2015.  Management of Dental
Patients taking Anticoagulants or Antiplatelet Drugs

BMC Oral Health 2015.  Managing Patients taking Novel Oral Anticoagulants
(NOAs) in Dentistry - A Discussion Paper on Clinical Implications

Post-Treatment Advice for Patients on Novel Oral Anti-Coagulants (NOACs).  
Treatment Algorithm for Patients on NOAC's