Nuevos anticoagulantes oralesrepercusión odontológica

Abstract

During the last years, cardiovascular patients who come to the dental office are increasing. The more prevalent cardiovascular pathologies are: hypertension, ischemic heart disease and rhythm alterations. Atrial fibrillation is the most frequent arrythmia. One of the most important bases in the medical attention in atrial fibrillation patients is the thromboembolic stroke prophylaxis, due to its importance and its potential prevention through anticoagulant drugs. The dicumarinics have been the most used anticoagulant drugs during the last 50 years, in order to prevent the embolism events. However, the arrival of novel oral anticoagulants (in English named “direct oral anticoagulants” or DOAC), warranted by clinical trials that involved more than 50.000 patients, has caused a revolution in the cardiovascular therapy; thus, the international guides recommendations for the atrial fibrillation treatment are changing. Therefore, the anticoagulant therapy with the DOAC constitutes a challenge in the dentist´s therapeutic attitude, and we would become familiar with its management protocol. They are safety drugs, although they could complicate an hemorrhagic situation, because they have no antidote (except Dabigatran). The objective of this review is to perform an update about the DOAC and its repercussion on the odontological treatment. Dabigatran, Rivaroxaban and Apixaban are reviewed, and also their pharmacologic properties, indications and contraindications, highlighting the protocol to follow in a potential hemorrhagic surgical procedure in the oral cavity.