Sir, I am in total agreement with Scully and Robinson (BDJ 2015; 219: 515). Oral anticoagulation with vitamin K antagonists has been used for several decades but has a number of limitations. New oral anticoagulants (dabigatran, rivaroxaban and apixaban) represent a new era in anticoagulation therapy but an area of concern with these medications is the treatment of complications of haemorrhage. The major drawback is the absence of an effective antidote.
Idarucizumab is the first dabigatran specific antidote under study.1 As a specific reversal agent for dabigatran, idarucizumab does not alter the effect of other oral anticoagulants.
Reversing dabigatran therapy with idarucizumab may expose patients to the thrombotic risk of their underlying disease.2 Idarucizumab will rarely be used in clinical practice.3 The introduction of the new oral anticoagulants poses a number of challenges in dental surgery. The number of patients prescribed new oral anticoagulants has been increasing and it is necessary to carefully evaluate the bleeding risk of dental treatment, as well as the thrombotic risk of suppressing the new oral anticoagulant.
References
Grottke O, Honickel M, van Ryn J, ten Cate H, Rossaint R, Spronk H M . Idarucizumab, a specific dabigatran reversal agent, reduces blood loss in a porcine model of trauma with dabigatran anticoagulation. J Am Coll Cardiol 2015; 66: 1518–1519.
Starke R M, Komotar R J, Connolly E S . A prospective cohort study of idarucizumab for reversal of dabigatran-associated hemorrhage. Neurosurgery 2015; 77: N11–13.
Traynor K . Idarucizumab approved for reversal of anticoagulant effects of dabigatran. Am J Health Syst Pharm 2015; 72: 2002–2004.
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Curto, A. Pharmacology: Dabigatran specific antidote. Br Dent J 220, 278 (2016). https://doi.org/10.1038/sj.bdj.2016.201
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DOI: https://doi.org/10.1038/sj.bdj.2016.201