Table 3 Summary of the more recent guidelines for dental management of patients taking NOAs

Firriolo FJ and Hupp WS, 2012 [1]

Dabigatran

For dental procedure that involve bleeding: do not discontinue the daily dose in patient with normal renal function and without other risk for impaired haemostasis

For oral and maxillofacial surgical procedures with possible complications for excessive bleeding and/or impaired haemostasis: discontinue dabigatran ≥ 24 h before surgery or longer depending on renal impairment and bleeding risk (Table 1).

Restart the drug at least 24 h postoperatively.

Rivaroxaban

For dental procedure that involve bleeding: do not discontinue the daily dose in patient with normal renal function and without other risk for impaired haemostasis

For oral and maxillofacial surgical procedures with possible complications for excessive bleeding and/or impaired haemostasis: discontinue rivaroxaban ≥ 24 h before surgery or longer depending on renal impairment and bleeding risk (Table 1).

Restart the drug at least 24 h postoperatively.

Davis C et al., 2013 [12]

Dabigatran

Perform surgery as long as possible after last dose

Use local haemostatic measures

Discontinue 2–3 half –lives before surgery

Adjust time of discontinuation for renal impairment

Hong CH and Islam I, 2013 [36]

Dabigatran, Rivaroxaban, Apixaban

Do not change administration

Use local haemostatic measures

Suspend administration 24 h before surgery and restart drugs after complete haemostasis is achieved at least after 24 h post-operatively

Breik O et al., 2013 [37]

Dabigatran

Do not discontinue the drug

Use local haemostatic measures (mechanical pressure, suturing an local haemostats)

In consultation with the patient’s physician, consider discontinuing the drug 24 h before procedure (or ≥ 48 h depending on degree of renal impairment) or changing to another anticoagulant preoperatively.

Consider checking aPTT preoperatively

Restart dabigatran 24–48 h after operation.