Navigating the New Landscape: Evidence-Based Dental Management of Patients on Direct Oral Anticoagulants (DOACs) and Novel Antiplatelet Agents

The introduction of Direct Oral Anticoagulants (DOACs) and Novel Antiplatelet Agents for routine use has greatly affected how the Dental Profession approaches its patients. The trend towards using these types of medications has increased the number of patients with drug therapy needs (due to atrial fibrillation, venous thromboembolism, heart disease, etc.) tremendously. Thus, the profession must ask itself: What procedures should Dental Professionals take to reduce the risk of increased bleeding complications or thromboembolic events from their patients? To answer this question, a thorough literature search of the scientific literature using multiple databases (PubMed, Google Scholar, Scopus, Elsevier, Springer, and others) for English language articles published from ۲۰۱۹ - ۲۰۲۳, including Clinical Trials, Observational Studies, Systematic Reviews, Meta-Analyses, and Recommendations from Professional Organizations has been performed. According to the literature, regardless of the source, there are no increased incidences of bleeding episodes for patients on anticoagulation/antiplatelet therapy during dental treatment unless the patient has had a major oral surgery. In most cases, if bleeding were to occur, it would be controlled by local measures, suturing, or rinsing with tranexamic acid. On the contrary, the risk of thrombosis increases significantly once an individual stops using antiplatelet therapy. The risk of thrombosis far outweighs the risk of bleeding; thus, the current clinical practice guidelines (SDCEP, AAOMS, ADA Guidelines) from late ۲۰۲۲ and early ۲۰۲۳ state that the vast majority of bleeding incidents are self-limiting, provided that anticoagulant medications remain in use. The research supports the continuation of anticoagulants as the preferred and safest means of treatment given the significantly higher incidence of thrombotic events that are associated with discontinuing anticoagulants.

کلیدواژه ها:

Direct oral anticoagulants ، DOACs ، novel antiplatelet agents ، dental management ، oral surgery ، perioperative care