Key result
Dabigatran management during oral surgery lacks consensus, requiring individualized care based on bleeding risk.
Why the study?
What is the risk of bleeding and the appropriate management strategy for patients taking dabigatran who undergo dental treatment?
Systematic Review (n=13)
What is the risk of bleeding and the appropriate management strategy for patients taking dabigatran who undergo dental treatment?
In the absence of strong clinical trial data, patients on dabigatran undergoing oral surgery should be managed on an individualized basis with minimally invasive techniques and local hemostatic measures.
Individualize dabigatran per thromboembolic/bleeding risk and renal function with local hemostasis; leaves open need for RCTs to guide dental protocols.
BACKGROUND: Dabigatran is a newly commercialized drug that is replacing other anticoagulants in the prevention of venous thromboembolism, stroke and systemic arterial valve embolism. It acts directly on thrombin presenting in a dynamic and predictable way, which does not require monitoring these patients. Therefore, we consider the need to assess whether their use increases the risk of bleeding involved before any dental treatment. MATERIAL AND METHODS: We performed a systematic review with a bibliographic search in PubMed/Medline along with the Cochrane Library. We excluded articles dealing with all anticoagulants other than dabigatran, and works about surgical treatments in anatomical locations other than the oral cavity. RESULTS: We included a total of 13 papers of which 1 was a randomized clinical trial, 9 narrative literature reviews, 1 case series, 2 clinical cases and 1 expert opinion. Because we did not obtain any properly designed clinical trials, we were unable to conduct a meta-analysis. CONCLUSIONS: Currently, there is no consensus on the procedure to be followed in patients taking dabigatran. However, all authors agree to treat each case individually in accordance to the risk of embolism, postoperative bleeding and renal function. Also, it is necessary to perform minimally invasive interventions, and take the appropriate local anti-hemolytic measures.
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Corcuera et al. (2016) conducted a systematic review in Patients taking dabigatran undergoing oral surgery (n=13). Dabigatran vs. Conventional anticoagulants or no withdrawal was evaluated on Consensus on management protocol and risk of bleeding. There is no consensus on managing patients taking dabigatran during oral surgery, though experts recommend individualized care based on bleeding risk, renal function, and minimally invasive techniques.
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