Miranda M, Martinez L S, Franco R, Forte V, Barlattani A, Bollero P
Department of Systems Medicine, Medical School, University of "Tor Vergata", Rome, Italy.
Department of Clinical Sciences and Translational Medicine, University of "Tor Vergata", Rome, Italy.
Oral Implantol (Rome). 2016 Nov 13;9(3):151-156. doi: 10.11138/orl/2016.9.3.151. eCollection 2016 Jul-Sep.
The oral anticoagulant therapy is used for the cure and the prevention of thromboembolic diseases. In the last fifty years the warfarin has been considered the oral anticoagulant of choice. However, its use is limited by a narrow therapeutic index and by a complex pharmacodynamics, which requires regular adjustments and monitoring of the dose. Recently, three new oral anticoagulant - dabigatran etexilato (direct thrombin inhibitor), rivaroxaban and apixaban (Xa factor direct inhibitor) - have been approved for use in europe. Increasing the number of patients taking these drugs, it is important that the dentist knows these new oral anticoagulants, their indications and methods of action, in particular for the management of patients, who require invasive treatments. With regard to the management of the patient threated with the new oral anticoagulants (NAO), there have been new significant changes in the procedure compared to the one followed by patients treated with warfarin. This led to the development of new guidelines that the dentist has to follow in order to ensure a safe and appropriate dental treatment and reduce any postoperative complications. The aim of this work is to evaluate the effectiveness of the new oral anticoagulants compared to warfarin, especially in terms of risks of bleeding events and intra and postoperative complications, in patients requiring multiple dental extractions.
口服抗凝治疗用于血栓栓塞性疾病的治疗和预防。在过去的五十年里，华法林一直被视为首选的口服抗凝剂。然而，其应用受到治疗指数狭窄和复杂药效学的限制，这需要定期调整和监测剂量。最近，三种新型口服抗凝剂——达比加群酯（直接凝血酶抑制剂）、利伐沙班和阿哌沙班（Xa因子直接抑制剂）——已在欧洲获批使用。随着服用这些药物的患者数量不断增加，牙医了解这些新型口服抗凝剂、其适应证和作用方式非常重要，特别是对于需要进行侵入性治疗的患者的管理。关于接受新型口服抗凝剂（NOA）治疗的患者的管理，与接受华法林治疗的患者相比，在操作程序上有了新的重大变化。这导致了新指南的制定，牙医必须遵循这些指南以确保安全、适当的牙科治疗并减少任何术后并发症。这项工作的目的是评估新型口服抗凝剂与华法林相比的有效性，特别是在需要多次拔牙的患者中出血事件以及术中及术后并发症风险方面。
