The New Oral Anticoagulants (NOACs) Between Prevention of Systemic Thromboembolism and Bleeding Procedures in the Dental Office: Review of Literature and Case Report

Anticoagulants are used for preventing or reducing blood clot formation and treatment of other related thrombotic disorders. Several types of anticoagulants are available, the old generation including, but not limited to Vitamin K antagonist, Unfractionated Heparin (UH) and Low Molecular Weight Heparins (LMWH) [1-3]. UH and LMWH have several drawbacks, such as: injectable administration and need to follow designated protocols assessing specific tests and dosage adjustments, whenever a bleeding oral intervention is required [1,2,4]. Vitamin K antagonists also have limitations because their absorption is influenced by the patient’s diet [5]. The old generation of oral anticoagulants have a more global action over the coagulation factors, and a less specific action on certain coagulation factors. Thus, the introduction of the new oral anticoagulants (NOACs) in 2008 was well received, given their specific design of counteracting the limitations of traditional anticoagulants [2,4]. NOACs target specific coagulation factors, either thrombin (Factor IIa) or Factor Xa [6]. The first drugs introduced of this class were thrombin inhibitors, thrombin being the key enzyme in the coagulation cascade [6,7]. The representative of this class is Dabigatran, a drug mainly used for preventing systemic embolism and stroke in patients with valvular atrial fibrillation [7]. On the other hand, Factor Xa inhibitors directly bind to the site of Factor Xa, thus blocking the common pathway of coagulation [8]. The first approved drugs were Apixaban and Rivaroxaban, with the addition of a more recent entry, Edoxaban [6,9]. The main disadvantage of NOACs is that their activity is difficult to monitor [10]. Crimson Publishers Wings to the Research Research Article