Pharmacology and Dental Implications of Novel Oral Anticoagulants

Novel oral anticoagulants (NOACs), direct thrombin inhibitor (dabigatran) and factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) are available in market as an alternative to warfarin. They are widely being prescribed by medical practitioners as these drugs overcome some of the major drawbacks with the existing medications. Absence of any specific management guidelines and lack of antidote are major concern for dental treatment of patients on NOACs. This review details the pharmacological profile of vitamin K anticoagulants and emerging NOACs. In order to assist dental professionals in decision making, case studies showing management of patients on NOACs undergoing dental treatment are also summarized. Since available data are not sufficient to establish an evidence-based dental management, the dentist must use caution and attention when treating patients taking dabigatran, rivaroxaban, apixaban and edoxaban.