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.
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.