Dental management of patients on direct oral anticoagulants: Case series and literature review

Objective: Rivaroxaban, apixaban, edoxaban, and dabigatran are the first direct oral anticoagulants (DOACs) to be cleared by the Food and Drug Administration for prevention of thromboembolic disorders. Patients previously taking conventional anticoagulants are now being treated with DOACs, and as a result, more dentists will be treating patients on DOACs in the community. At present, there is no validated monitoring test that can estimate bleeding risk for patients on DOACs, and the available dental literature is based on case reports and expert opinions. It is unclear whether the dose of DOACs should be continued, partially interrupted for 1 day, or completely interrupted for longer than 2 days prior to dental treatment. The aim in this case series is to describe the dental treatment of patients on DOACs and the outcomes of dental treatment for these three clinical approaches. Method and Materials: We report on a series of patients on DOACs seen in a hospital dental clinic and the outcomes of dental treatment for three clinical approaches: continuation of DOACs throughout dental treatment, partial interruption of DOACs 1 day prior to dental treatment, or complete interruption of DOACs for longer than 2 days prior to dental treatment. Results: None of the patients exhibited significant postoperative bleeding regardless of approach. Clinically significant postoperative complications were managed without difficulty. Conclusion: Our experience suggests that dental treatment may be safely delivered following continuation, partial interruption, or complete interruption of the DOAC dose for dental treatment. Large-scale comparative studies are warranted to assess the preferred clinical approach. Keywords: anticoagulant, bleeding, dental, direct, management, oral