Patient taking direct oral anticoagulants (DOACs) has to undergo oral surgery – considerations for practitioners

Haemostasis is an excellently orchestrated process; however, thrombosis or excessive bleeding can result in a breakdown of this subtly regulated mechanism. Anticoagulants prevent the formation of thrombi by blocking the coagulation cascade. Surgical interventions in anticoagulated patients carry a risk of periprocedural bleeding. Over the last decade, new agents – direct oral anticoagulants (DOACs) – were introduced into clinical practice to overcome the drawbacks of classic agents used for the prevention of thrombotic events. The most remarkable difference in comparison with traditional anticoagulants is the elimination of the need for monitoring. The article covers periprocedural management in DOAC-treated patients undergoing oral surgery procedures. Direct oral anticoagulants are characterized, paying attention to pharmacokinetic properties important for oral surgeons. Bleeding risk related to oral and dental implant surgery procedures are presented, followed by considerations crucial for the evaluation of patient-related bleeding factors. Aspects of surgical planning are discussed. Adequate measures and aids helpful in oral surgery interventions together with post-operative care are also summarized.