Use of new oral anticoagulants in oral surgery
In recent years, many new antithrombotic drugs found their way to the market and the number of (elderly) patients taking these drugs is increasing. The risk of bleeding during and after surgical procedures is higher for patients taking antithrombotics than for patients not taking these drugs. Tooth extraction may seem a simple, daily procedure for dentists and oral and maxillofacial surgeons, but is more complicated when the patient is taking oral anticoagulants. Therefore, the need for a simple guideline concerning the management of oral anticoagulants and local haemostatic measures in the context of dental extraction is high.
A prospective study performed at KU Leuven University, Belgium, has proven that a pragmatic approach of skipping only the morning dose of a new oral anticoagulant (NOAC) allows performing tooth extractions safely. A step from this, the study also showed that there is an increased risk of delayed postoperative bleeding events after restarting the NOAC. Therefore, the EXTRACT-NOAC study (an acronym of ‘Tranexamic Acid To Reduce Bleeding in Patients Treated with New Oral Anticoagulants Undergoing Dental Extraction’) was set up. The aim of this prospective, randomized, double-blind, placebo-controlled, multi-centre, phase IV, clinical trial is to analyse whether adding TXA 10% mouthwash to standard-of-care procedures decreases the number of post-extraction bleeding events in patients taking NOACs. Since topical application of TXA results in minimal systemic absorption, TXA mouthwash may reduce postextraction bleeding without systemic effects. Therefore, TXA is an attractive and effective local haemostatic agent.
The EXTRACT-NOAC study is being performed in view of drafting guidelines concerning the postoperative management of patients treated with NOACs and undergoing tooth extractions. In this way, the postoperative care of this patient group can be assured and will improve.
Prof. dr. Reinhilde Jacobs