Case report of tooth extraction in 31 patients receiving non-vitamin K antagonist oral anticoagulants (NOACs)

The non-vitamin K antagonist, oral anticoagulant (NOAC) direct thrombin inhibitor dabigatran and the Xa inhibitors rivaroxaban and apixaban are now being used clinically. We retrospectively studied tooth extraction in patients who received NOACs in our department. The medical charts of these patients were investigated. From April 2011 through November 2015, 31 patients who were receiving NOACs underwent tooth extraction in the hospital. Among the 31 patients, 16 patients received dabigatran, 7 rivaroxaban, and 8 apixaban. Tooth extraction was performed in 19 patients who were receiving NOACs while maintaining conventional anticoagulant therapy and in 12 patients in whom NOACs were withdrawn before tooth extraction and resumed within 24 hours. The activated partial thromboplastin time (APTT) and the prothrombin time-international normalized ratio (PT-INR) were checked at the initial visit and immediately before tooth extraction, and were both prolonged slightly. There was no bleeding episode or thromboembolism in any patient who received NOACs. Monitoring of the APTT and PT-INR has been reported to be useful, and tooth extraction has to be performed with care in patients with markedly prolonged APTT and PT-INR. In patients who undergo tooth extraction while receiving NOACs, maintaining conventional anticoagulant therapy or stopping therapy before tooth extraction and resuming it within 24 hours has been suggested to be an effective way to reduce the risk of postoperative bleeding.