Dabigatran and rivaroxaban, new oral anticoagulants. new approaches in dentistry

Treatment in patients with atrial fibrillation or venous thromboembolism in recent decades has been based almost exclusively on the use of vitamin K antagonists. These drugs have a narrow therapeutic index, so it is precise to repeated adjustments of doses that require analytical monitoring. For many years it has advocated the need to have more convenient new antithrombotic drugs. So is developing a new generation of antithrombotic not related to coumarin. In 2008 and 2009, two of these new anticoagulants have been registered and approved in Europe and Ca- nada-these are dabigatran etexilate (Pradaxa ®) and rivaroxaban (Xarelto ®). Anticoagulant dabigatran is the first direct thrombin inhibitor, orally available. Specifically and reversibly inhibits thrombin, so the duration of action is predictable. The anticoagulant effect correlates well with plasma drug concentrations, which implies an effective anticoagulation with low bleeding risk without major problems of interactions with other drugs. Rivaroxaban is first oral anticoagulant inhibitor of factor Xa (FXa). It produces a predictable and reversible inhibition of FXa activity with ability to inhibit clot-bound FXa. The predictable pharmacokinetics and pharmacodynamics characteristics of dabigatran and rivaroxaban may facilitate dental management of patients who until now have been in treatment with traditional anticoagulants, given that it doesn’t require routine laboratory monitoring in the vast majority of patients treated. They also present a profile of drug interactions very favourable.