Anticoagulants

ANTICOAGULANTS

• Coumarins
• Heparin and derivative substances
• Synthetic pentasaccharide inhibitors of factor Xa (fondaparinux, idraparinux, idrabiotaparinux)
• Directly acting oral anticoagulants (Xa inhibitors rivaroxaban, apixaban, edoxaban, betrixaban),  are in current use.   Direct thrombin inhibitors (hirudin, lepirudin, bialirudin, argatroban, dabigatran) are expected to replace heparin but are not in widespread use. 
• Antithrombin protein therapeutics
• Novel anticoagulants

ANTIPLATLET DRUGS

Note about dual antiplatlet therapy: Patients are often prescribed ASA plus a ADP/P2Y inhibitor. This is referred to as dual antiplatelet therapy (DAPT).  

• Irreversible cycoloxygenase inhibitors (ASA)
• Adenosine diphosphate receptor inhibitors (Plavix, Brillanta, Ticlid)
• Phosphodiesterase inhibitors (Pletal)
• PAR-1 antagoists (Zontivity)
• IIB/IIIA inhibiros (IV only) (ReoPro, Integrillin, Aggrastat)
• Adenosine reuptake inhibitors (Persantine)
• Thromboxane inhibitors

Guidance from the Scottish Dental Society on low vs high risk procedures is included below. In general, consult with the patients physician before stopping anticoagulation for high risk procedures and consider the use of local hemostatic measures such as Surgicel and/or gelfoam. 

In addition; consider use of Point of Care device to measure INR for patients who are on coumadin, and limiting dentoalveolar surgery to INR <3.0. Antiplatlet medications may need to be stopped 7 days prior to surgery, and Xa anticoagulants 1-2 days prior in consultation with the patients physician. 

TABLE 1: POST-OPERATIVE BLEEDING RISKS FOR DENTAL PROCEDURES