The Principles of Taking New Generation Oral Anticoagulants in Dental Patients

Yıl 2013, Cilt: 7 Sayı: 2, 1485 - 1500, 01.07.2013

Ayşe Bulut Ömer Engin Bulut Deniz Erbaş

Öz

The management of patients receiving oral anticoagulant drug therapy with forthcoming dental surgical procedures has been changed dramatically nowadays. In the recent years new generation of orally administered, fixed dose, anticoagulant drugs that do not require laboratory management and do not interact much with other medicines or foods has been developed. New oral anticoagulants which offer similar efficacy to traditional drugs are categorized, on the basis of their targets, as direct thrombin inhibitors dabigatran etexilat or activated factor X FX inhibitors rivaroxaban, apixaban . Dabigatran etexilate, rivaroxaban, apixaban are three recently introduced drugs for the treatment of patients affected by various diseases and medical conditions that require use of extended-duration anticoagulant therapy. Even though specific antidotes are available for these drugs, surgical dental treatment of patients taking new oral anticoagulants requires particular attention in light of the bleeding risk associated to the procedure. Interruption of the new oral anticoagulants administration usually is not necessary for simple surgery such as single dental extraction. However, suspension has to be considered for extensive surgical treatments and/or in cases of patient’s comorbidities such as renal impairment, advanced age or concomitant anti-platelet therapies

Anahtar Kelimeler

Anticoagulants, dabigatran, rivaroxaban, apixaban

Dişhekimliği Hastalarında Yeni Nesil Oral Antikoagülan Kullanım Prensipleri

Öz

Dental cerrahi işlem yapılacak kan sulandırıcı alan hastaların tedavisi günümüzde önemli ölçüde değişmiştir. Son yıllarda, oral olarak uygulanan, sabit dozda, laboratuvar takibine gerek olmayan ve diğer ilaç ve gıdalarla çok etkileşime girmeyen bir dizi yeni nesil oral antikoagülan geliştirilmiştir. Geleneksel ilaçlara benzer etkinlik sunan yeni nesil oral antikoagülanlar, hedeflerine göre direkt trombin inhibitörleri dabigatran eteksilat ya da aktive edilmiş faktör X inhibitörleridir rivaroksaban, apiksaban . Dabigatran eteksilat, rivaroksaban ve apiksaban, uzun süre antikoagülan tedavi gerektiren, çeşitli hastalıklar ve tıbbi koşullardan etkilenen hastaların tedavisi için en son ortaya çıkan üç ilaçtır. Bu ilaçların antidotu olsa da, yeni nesil oral antikoagülan alan hastaların dental cerrahi tedavilerinde işlemlere bağlı düşük kanama riski nedeniyle dikkatli olunmalıdır. Genellikle, tek diş çekimi gibi basit cerrahi işlemlerde yeni nesil oral antikoagülanların uygulamasına ara verilmesine gerek yoktur. Ancak, büyük cerrahi tedavilerde ve/veya böbrek yetmezliğinde, ileri yaştaki veya antitrombosit tedavi alan hastalarda yeni nesil oral antikoagülanların uygulamasına ara verilmesi düşünülmelidir

Anahtar Kelimeler

Antikoagülanlar, dabigatran, rivaroksaban, apiksaban

Kaynakça

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