Clinical study of tooth extraction in patients receiving dabigatran

Dabigatran is a novel oral anticoagulant (NOAC) and a direct thrombin inhibitor. There is limited information available about tooth extraction in patients receiving dabigatran because of its status as an NOAC. We studied the safety of tooth extraction in 19 patients who continued to receive dabigatran. The average age was 72.0 years, and a total of 55 teeth were extracted. The mean active partial thromboplastin time (APTT) was 45.4 seconds. In 1 patient the APTT was prolonged to more than 70 seconds. All patients underwent tooth extraction 6 to 8 hours after taking dabigatran in consideration of the half-life in blood. Postoperative bleeding occurred in the patient in whom the APTT was prolonged to more than 70 seconds. Dabigatran had to be temporarily withdrawn in 1 patient and resumed after the cessation of bleeding. Measurement of APTT before extraction is essential. We consider tooth extraction feasible without the cessation of dabigatran if the patient’s APTT is controlled to less than 2 times the reference value. If the APTT is prolonged to longer than 60 seconds, tooth extraction must be carefully performed.