New oral anticoagulants -the newest update in patients undergo oral surgery

During the past 20 years, the approval of anticoagulants such as low-molecular-weight heparins (LMWHs), indirect factor Xa inhibitors and direct thrombin inhibitors has signaled a growing interest in antithrombotic compounds that have relatively discrete targets within the coagulation pathway. Aim of this study is to review the evidence of different therapy approach, to highlight the areas of major concern, and to suggest specific oral surgery treatment for patients on new oral anticoagulants. Material and method: A Medline and an extensive hand search were performed on English-language publications beginning in 1971 till now. The pertinent literature and clinical protocols of hospital dentistry departments have been extensively reviewed, presented and discussed. Results: Several evolving clinical practices in the last years have been detected: - anticoagulants are generally not discontinued; - oral surgery is performed despite laboratory values showing significant bleeding tendency; - new effective local hemostatic modalities are used to prevent bleeding; - Patients at risk are referred to hospital-based clinics. Conclusion: The management of oral surgery procedures on patients treated with new anticoagulants should be influenced by several factors: laboratory values, extent and urgency of the intervention, treating physician’s recommendation, available facilities, dentist expertise, and patient’s oral, medical, and general condition. Key words: oral surgery, oral anticoagulants, low-molecular heparin, bleeding