Dental implications of novel oral anticoagulants

I read with interest the article ‘Warfarin and Drug Interactions: Prescribing Vigilance’ by Hook J et al (Dent Update 2016; 43: 34–36) about warfarin and their drug interactions in dental management.¹

Anticoagulation with low molecular weight heparin and vitamin K antagonists is the current standard of care for venous thrombo-embolism treatment and prevention. For the past decades, warfarin has been considered the mainstay of treatment, but its use is limited by a narrow therapeutic index that necessitates regular monitoring of the international normalized ratio (INR) and adjustments to the dose accordingly. Its use is also limited by drug interactions. Novel oral anticoagulants (dabigatran, rivaroxaban and apixaban) represent a new era in anticoagulation therapy. These novel oral anticoagulants have been developed and come in two categories: activated factor X inhibitors (rivaroxaban and apixaban) and a direct thrombin inhibitor (dabigatran). These new drugs do not require the INR to be monitored.²