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CC BY-NC-ND 4.0 · European Journal of General Dentistry 2017; 6(01): 1-4
DOI: 10.4103/2278-9626.198585
Review Article

Management of patients taking rivaroxaban for dental treatments

Adrian Curto
Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
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Abstract

There are several novel anticoagulant drugs that are being increasingly used as an alternative to warfarin and acenocoumarol. Novel oral anticoagulants have emerged in recent years to overcome some of the drawbacks of classic oral anticoagulants. Rivaroxaban, dabigatran, apixaban, and edoxaban were approved by the Food and Drug Administration and European Medicines Agency. This paper examines the available evidence regarding rivaroxaban and sets out proposals for the clinical guidance of dental practitioners treating these patients in primary dental care. Literature search was conducted through May 2016 for publications in the ISI Web of Knowledge, PubMed, and Cochrane Library using the keywords, “rivaroxaban,” “dabigatran,” “apixaban,” “edoxaban,” “new oral anticoagulants,” “novel oral anticoagulants,” “bleeding,” and “dental treatment.” For patients requiring minor oral surgery procedures, interruption of rivaroxaban is not generally necessary while a higher control of bleeding and discontinuation of the drug (at least 24 h) should be requested before invasive surgical procedure, depending on renal functionality. Their increased use means that oral care clinicians should have a sound understanding of the mechanism of action, pharmacology, reversal strategies, and management of bleeding in patients taking rivaroxaban. Currently, recommendations are based on poor quality scientific data and clinical trials are required to establish best evidence-based practice guidance.

Keywords

Apixaban - bleeding - dabigatran - edoxaban - novel oral anticoagulants - rivaroxaban


Publication History

Article published online:
01 November 2021

© 2017. European Journal of General Dentistry. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 How CH. Novel oral anticoagulants for atrial fibrillation. Singapore Med J 2015;56:657-8.
  • 2 Wittkowsky AK. Novel oral anticoagulants and their role in clinical practice. Pharmacotherapy 2011;31:1175-91.
  • 3 Frost C, Song Y, Barrett YC, Wang J, Pursley J, Boyd RA, et al. A randomized direct comparison of the pharmacokinetics and pharmacodynamics of apixaban and rivaroxaban. Clin Pharmacol 2014;6:179-87.
  • 4 Siegal DM, Curnutte JT, Connolly SJ, Lu G, Conley PB, Wiens BL, et al. Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med 2015;373:2413-24.
  • 5 ROCKET AF Study Investigators. Rivaroxaban-once daily, oral, direct factor Xa inhibition compared with Vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation: Rationale and design of the ROCKET AF study. Am Heart J 2010;159:340-7.e1.
  • 6 Rondina M. ACP Journal Club: In nonvalvular atrial fibrillation, effects of rivaroxaban compared with warfarin did not differ by patient age. Ann Intern Med 2014;161:JC5.
  • 7 Firriolo FJ, Hupp WS. Beyond warfarin: The new generation of oral anticoagulants and their implications for the management of dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:431-41.
  • 8 Nutescu E, Chuatrisorn I, Hellenbart E. Drug and dietary interactions of warfarin and novel oral anticoagulants: An update. J Thromb Thrombolysis 2011;31:326-43.
  • 9 Costantinides F, Rizzo R, Pascazio L, Maglione M. Managing patients taking novel oral anticoagulants (NOAs) in dentistry: A discussion paper on clinical implications. BMC Oral Health 2016;16:5.
  • 10 Rodgers R, Bagot CN, Lawrence C, Hickman G, McGurk M, Tait RC. Correlating prothrombin time with plasma rivaroxaban level. Br J Haematol 2013;163:685-7.
  • 11 Samama MM, Contant G, Spiro TE, Perzborn E, Flem LL, Guinet C, et al. Evaluation of the prothrombin time for measuring rivaroxaban plasma concentrations using calibrators and controls: Results of a multicenter field trial. Clin Appl Thromb Hemost 2012;18:150-8.
  • 12 Nogi K, Kawasugi K, Matsuzawa M, Okufuji Y, Shimadu C, Miyazawa Y, et al. Changes in PT and APTT when administrating rivaroxaban, a direct inhibitor of activated factor X. Rinsho Byori 2015;63:194-200.
  • 13 Siegal DM, Konkle BA. What is the effect of rivaroxaban on routine coagulation tests? Hematology Am Soc Hematol Educ Program 2014;2014:334-6.
  • 14 Hillarp A, Gustafsson KM, Faxälv L, Strandberg K, Baghaei F, Fagerberg Blixter I, et al. Effects of the oral, direct factor Xa inhibitor apixaban on routine coagulation assays and anti-FXa assays. J Thromb Haemost 2014;12:1545-53.
  • 15 Douxfils J, Tamigniau A, Chatelain B, Chatelain C, Wallemacq P, Dogné JM, et al. Comparison of calibrated chromogenic anti-Xa assay and PT tests with LC-MS/MS for the therapeutic monitoring of patients treated with rivaroxaban. Thromb Haemost 2013;110:723-31.
  • 16 Scott A, Gibson J, Crighton A. The management of dental patients taking new generation oral anticoagulants. Prim Dent J 2014;3:54-8.
  • 17 Mehta RS. Novel oral anticoagulants for prophylaxis and treatment of venous thromboembolism: Part I (factor Xa inhibitors). Expert Rev Hematol 2010;3:227-41.
  • 18 Curtin C, Hayes JM, Hayes J. Dental implications of new oral anticoagulants for atrial fibrillation. Dent Update 2014;41:526-8, 530-1.
  • 19 Elad S, Marshall J, Meyerowitz C, Connolly G. Novel anticoagulants: General overview and practical considerations for dental practitioners. Oral Dis 2016;22:23-32.
  • 20 Tsolka P. Dental procedures in patients with atrial fibrillation and new oral anticoagulants. Arrhythm Electrophysiol Rev 2014;3:85-9.
  • 21 Mingarro-de-León A, Chaveli-López B. Alternative to oral dicoumarin anticoagulants: Considerations in dental care. J Clin Exp Dent 2013;5:e273-8.
  • 22 Gómez-Moreno G, Aguilar-Salvatierra A, Fernández-Cejas E, Delgado-Ruiz RA, Markovic A, Calvo-Guirado JL. Dental implant surgery in patients in treatment with the anticoagulant oral rivaroxaban. Clin Oral Implants Res 2016;27:730-3.
  • 23 Levy JH, Key NS, Azran MS. Novel oral anticoagulants: Implications in the perioperative setting. Anesthesiology 2010;113:726-45.
  • 24 Crowther MA, Warkentin TE. Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: Focus on new anticoagulant agents. Blood 2008;111:4871-9.
  • 25 O′Connell JE, Stassen LF. New oral anticoagulants and their implications for dental patients. J Ir Dent Assoc 2014;60:137-43.
  • 26 Bacci C, Maglione M, Favero L, Perini A, Di Lenarda R, Berengo M, et al. Management of dental extraction in patients undergoing anticoagulant treatment. Results from a large, multicentre, prospective, case-control study. Thromb Haemost 2010;104:972-5.
  • 27 Eerenberg ES, Middeldorp S, Levi M, Lensing AW, Büller HR. Clinical impact and course of major bleeding with rivaroxaban and Vitamin K antagonists. J Thromb Haemost 2015;13:1590-6.
  • 28 Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: A randomized, placebo-controlled, crossover study in healthy subjects. Circulation 2011;124:1573-9.