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Objectives: Recent developments of new direct oral anticoagulants that target specific clotting factors necessitate
understanding of coagulation biology. The objective of this tutorial is to offer dental
professionals a review of
coagulation mechanisms and the
pharmacodynamics of the conventional and new oral anticoagulants. Also, we
summarized the dental implications of the conventional and new anticoagulants.
Method
: We searched Medline using search terms "antithrombotic", "antihemostasis" or "anticoagulation" and
combined them with the search results of "dental", "oral surgery" or "periodontal". We restricted the results to
"human" and "English".
Results: The early coagulation cascade, the new cell-based coagulation model, the
pharmacokinetics and
pharmacodynamics of conventional antithrombotics, and new oral anticoagulants were reviewed. The new direct factor
Xa inhibitors and the direct thrombin inhibitor (s), called direct oral anticoagulants (DOAs) have rapid onset of
action, fast elimination on cessation, and fewer drug-drug or drug-food interactions than warfarin. However, the
lack of antidotes raises concerns that some dental
procedures may trigger serious hemorrhagic events. Additionally, careful
perioperative withdrawal and resumption
protocols for the DOAs are reviewed, because DOAs' blood
levels are dependent on renal function. Also, various reversal strategies in the event of excessive bleedings are
summarized. Perioperative management of dental
patients taking new DOAs and conventional oral anticoagulants
are also discussed. However, the
perioperative strategies for DOAs are yet to be validated in randomized trials.
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