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Novel Oral Anti-Coagulants (NOAC’s) & Oral Surgery

Dabigatran, Apixaban and Rivaroxaban are novel / new oral anti-coagulants (NOAC’s) 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 & Apixaban).

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)
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
NOAC’s & the Clotting Pathway
Treatment Algorithm for Patients on NOAC's
Treatment Algorithm for Patients on NOAC’s

Useful Articles & Websites

Scottish Dental Clinical Effectiveness Programme

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 Setting

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 Patients

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).