Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
Medicine is constantly changing and evolving. Along with these changes are newer and better medications. Attempting to keep current and abreast of these changes can be daunting especially for the dentist. One example of this issue was a recent telephone call. A general dentist was referring his patient to our office for the removal of a fractured bicuspid tooth. Just before the end of the telephone call he casually mentioned that his patient is on a "new" medication. "Bye the way" he added, "It causes bleeding". When asked for the name of the medication he laughed and replied, "I'm really not sure." It seems that neither he nor his patient can pronounce the name of the medication.
The medication was Dabigatran. It is also commonly known as Pradaxa and it is a recently licensed anticoagulant which significantly reduces the risk of stroke or systemic emboli in patients with atrial fibrillation (AF) and those having joint replacement surgery. Adult patients with previous stroke, transient ischemic attack (TIA) as well as other medical conditions are also candidates for Dibigatran. You, as a dental practitioner, are likely to be seeing patients taking Dibigatran, and may appreciate a greater understand as to the management of these patients.
Dabigatran directly inhibits thrombin in the coagulation cascade and prevents clot formation. Unlike warfarin (Coumadin) in which its therapeutic levels are monitored by its INR; dosing is based upon creatinine clearance (CrCl). For warfarin, the INR is used to determine whether dental procedures can be completed in a dental setting. Patients with a stable INR less than 4.0 can be treated safely if the dental procedures are simple.
For Dibigatran, routine dental treatment up to three extractions can be done in the general dental setting without altering the drug dose.
If unwanted hemorrhage occurs, the source of the bleeding should be located and managed using local hemostatic measures.
Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of bleeding.
Dabigatran offers significant benefits compared to Warfarin and is easier to use for both the patient and the clinician. Becoming more familiar with this medication is appropriate as more of your patients may begin to have it prescribed for them.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery