Ruigómez A, Johansson S, Wallander MA, Rodríguez LA Incidence of chronic atrial fibrillation in general practice and its treatment pattern. J Clin Epidemiol. 2002; 55:(4)358-363
Kannel WB, Wolf PA, Benjamin EJ, Levy D Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998; 82:(8A)2N-9N
Keeling D, Baglin T, Tait C, Watson H, Perry D, Baglin C Guidelines on oral anticoagulation with warfarin. Br J Haematol. 2011; 154:(3)311-324
Fitzmaurice DA, Murray ET, McCahon D, Holder R, Raftery JP, Hussain S Self management of oral anticoagulation: randomised trial. Br Med J. 2005; 331:(7524)
Camm AJ, Lip GY, De Caterina R, Savelieva I, Star D, Hohnloser SH 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. ▪ Developed with the special contribution of the European Heart Rhythm Association.2012
TA249 Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation. http://guidance.nice.org.uk/ta249
Stangier J Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin inhibitor dabigatran etexilate. Clin Pharmacokinet. 2008; 47:(5)285-295
Uchino K, Hernandez AV Dabigatran association with higher risk of acute coronary events: meta-analysis of noninferiority randomized controlled trials. Arch Intern Med. 2012; 172:(5)397-402
Legrand M, Mateo J, Aribaud A, Ginisty S, Eftekhari P, Huy PT The use of dabigatran in elderly patients. Arch Intern Med. 2011; 171:(14)1285-1286
TA256 Rivaroxaban for the Prevention of Stroke and Systemic Embolism in People with Atrial Fibrillation. http://guidance.nice.org.uk/TA256
Garcia D, Libby E, Crowther MA The new oral anticoagulants. Blood. 2010; 115:(1)15-20
TA275 Apixaban for Preventing Stroke and Systemic Embolism in People with Nonvalvular Atrial Fibrillation. http://guidance.nice.org.uk/TA275
Raghavan N, Frost CE, Yu Z, He K, Zhang H, Humphreys WG Apixaban metabolism and pharmacokinetics after oral administration to humans. Drug Metab Dispos. 2009; 37:(1)74-81
van Ryn J, Litzenburger T, Waterman A, Canada K, Hauel N, Sarko C Dabigatran anticoagulant activity is neutralized by an antibody selective to dabigatran in in vitro and in vivo models. J Am Coll Cardiol. 2011; 57
Baglin T, Keeling D, Kitchen S Effects on routine coagulation screens and assessment of anticoagulant intensity in patients taking oral dabigatran or rivaroxaban: Guidance from the British Committee for Standards in Haematology. Br J Haematol. 2012; 159:(4)427-429 https://doi.org/10.1111/bjh.12052
As dental professionals, we should all be familiar with the most common oral anticoagulant, warfarin, and how to manage our patients that are taking it. However, several new oral anticoagulants which have recently been approved by the National Institute for Health and Care Excellence (NICE) are now being prescribed for patients in the United Kingdom. These new oral anticoagulants fall into two different categories: a direct thrombin inhibitor dabigatran etexilate (Pradaxa® Boehringer-Ingelheim, Bracknell, Berkshire) and activated Factor X inhibitors rivaroxaban (Xarelto® Bayer HealthCare, Newbury, Berkshire) and apixaban (Eliquis® Bristol-Myers Squibb, Uxbridge, Middlesex). These new drugs will have potential consequences for how dental practitioners manage patients requiring dental treatment, especially extractions and minor surgical procedures.
Clinical Relevance: It is important that dentists are aware of new anticoagulants which are being prescribed for patients to ensure that they receive safe and appropriate dental treatment. As healthcare professionals we should also be aware of how and when to report adverse drug reactions.
Article
Atrial fibrillation is the most common sustained cardiac arrhythmia in Europe and North America with about 46,000 new cases diagnosed in the UK every year.1 The prevalence of atrial fibrillation increases with advancing age, with a 0.5% incidence in 50–59 year-olds increasing to 9% in 80–89 year-olds.2 Given that the proportion of older people in the UK population is increasing, it is likely that the prevalence of this condition will increase significantly in the next 50 years, inevitably leading to more patients being prescribed anticoagulant drugs. This same group of older people are retaining their natural teeth longer and will potentially require extractions and minor oral surgical procedures, and so dental practitioners will need to be aware of the implications of these drugs.
For the last 50 years, warfarin has been the drug of choice for oral anticoagulation in atrial fibrillation3 and it is estimated that about 950,000 people are taking the drug in the UK.4 However, newer oral anticoagulants, such as dabigatran etexilate (Pradaxa®), rivaroxaban (Xarelto®) and apixaban (Eliquis®) may now offer an alternative to warfarin. The European Society of Cardiology has updated its Guidelines for the Management of Atrial Fibrillation5 to include these drugs and the NICE Clinical Guideline 36, ‘The Management of Atrial Fibrillation,’ is in the process of being updated taking these new oral anticoagulants into consideration. This update is due for publication in June 2014.
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