Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs



Download 199.67 Kb.
Page9/9
Date conversion17.11.2016
Size199.67 Kb.
1   2   3   4   5   6   7   8   9

Appendix 4. Interactions with Drugs Prescribed by Dentists


Appendix 4 shows a table of possible interactions and effects between anticoagulants or antiplatelet medications and drugs prescribed by dentists. This has been compiled from information contained in the current BNF19, the individual drug Summary of Product Characteristics (SPCs; www.medicines.org.uk) and with expert advice. Drugs which are likely to increase the anticoagulant or antiplatelet effect of the existing medication, and therefore have the potential to increase bleeding risk, are indicated in red. Those which may decrease the anticoagulant or antiplatelet effect of the existing medication, and therefore have the potential to increase the patient’s thromboembolic risk, are indicated in blue.

The information provided summarises the main interactions and may not be exhaustive. The information is correct at time of publication but may be subject to change, especially for the newer drugs. For further information refer to the current version of the BNF at www.medicinescomplete.com, the individual drug SPCs at www.medicines.org.uk and SDCEP Drug Prescribing For Dentistry guidance.37






Interactions (and possible effects)

Oral Anticoagulants




warfarin

Penicillinsa including co-amoxiclav (reports of increased INR with amoxicillinb)

Metronidazole, erythromycin, clarithromycin (anticoagulant effect enhanced in a minority of patients)

NSAIDsc; aspirin, ibuprofen, diclofenac (may increase bleeding risk)



Carbamazepine (reduced anticoagulant effect)

Miconazole, fluconazole (established and clinically important increase in anticoagulation effect)

phenindione

acenocoumarol

Oral Antiplatelet Drugs




aspirin

NSAIDsc: ibuprofen, diclofenac (may increase bleeding risk, although note that the antiplatelet effect of aspirin may be reduced by ibuprofen if used regularly)

clopidogrel

NSAIDsc; aspirin, ibuprofen, diclofenac (may increase bleeding risk)

Erythromycin (may reduce antiplatelet effect)

Carbamazepine (may reduce antiplatelet effect)

Fluconazole (may reduce antiplatelet effect)

Omeprazole (may reduce antiplatelet effect)

dipyridamole

Aspirinc (may increase bleeding risk)

prasugrel

NSAIDsc; aspirin, ibuprofen, diclofenac (may increase bleeding risk)

ticagrelor

NSAIDsc; aspirin, ibuprofen, diclofenac (may increase bleeding risk)

Clarithromycin (plasma concentration of ticagrelor may be increased)

Carbamazepine (plasma concentration of ticagrelor may be reduced)

NOACsd




apixaban

NSAIDsc; aspirin, ibuprofen, diclofenac (may increase bleeding risk)

Carbamazepine (plasma concentration of apixaban may be reduced)

dabigatran

NSAIDsc; aspirin, ibuprofen, diclofenac (may increase bleeding risk)

Clarithromycin (may increase bleeding risk)

Carbamazepine (plasma concentration of dabigatran may be reduced)

rivaroxaban

NSAIDsc; aspirin, ibuprofen, diclofenac (may increase bleeding risk)

Carbamazepine (plasma concentration of rivaroxaban may be reduced)

Injectable Anticoagulants




dalteparin

NSAIDsc; aspirin, ibuprofen, diclofenac (may increase bleeding risk)

enoxaparin

tinzaparin

a Fever or infection can affect coagulation or drug metabolism therefore any patient systemically unwell enough to require an antibacterial may have an altered coagulation status.

b Since the INR can be increased, if antibiotics such as amoxicillin are prescribed the patient’s INR should be rechecked after 24 hours.

c The use of NSAIDs is discouraged in patients with vascular disease, because of their antiplatelet action. Simple analgesics (paracetamol, co-codamol) should be tried first. If an NSAID is required, treatment length should be kept to a minimum.

d Also known as DOACs or TSOACs (see Section 1).

References


1. Barnes GD, Ageno W, Ansell J, Kaatz S, for the Subcommittee on the Control of Anticoagulation. Recommendation on the Nomenclature for Oral Anticoagulants: communication from the SSC of the ISTH. J Thromb Haemost. 2015;13:1154-6.

2. Randall C. Surgical Management of the Primary Care Dental Patient on Warfarin: North West Medicines Information Centre. 2007; (www.app.dundee.ac.uk/tuith/Static/info/warfarin.pdf. Accessed 06/02/15).

3. Perry DJ, Noakes TJ, Helliwell PS, British Dental S. Guidelines for the Management of Patients on Oral Anticoagulants Requiring Dental Surgery. Br Dent J. 2007;203(7):389-393.

4. Aframian DJ, Lalla RV, Peterson DE. Management of Dental Patients Taking Common Hemostasis-altering Medications. Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 2007;103 Suppl:S45.e41-11.

5. Randall C. Surgical Management of the Primary Care Dental Patient on Antiplatelet Medication: North West Medicines Information Centre. 2010; (www.app.dundee.ac.uk/tuith/Static/info/antiplatelet.pdf Accessed 06/02/15).

6. Scott A, Gibson J, Crighton A. The Management of Dental Patients Taking New Generation Oral Anticoagulants. Primary Dental Journal. 2014;3(4):54-58.

7. Hawkins D. Limitations of traditional anticoagulants. Pharmacotherapy. 2004;24(7 Pt 2):62S-65S.

8. Firriolo FJ, Hupp WS. Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(4):431-441.

9. Scaglione F. New oral anticoagulants: comparative pharmacology with vitamin K antagonists. Clinical pharmacokinetics. 2013;52(2):69-82.

10. Atrial fibrillation: the management of atrial fibrillation (CG180). National Institute for Health and Care Excellence; 2014. (www.nice.org.uk/guidance/cg180 Accessed 06/02/15).

11. Capodanno D, Ferreiro JL, Angiolillo DJ. Antiplatelet therapy: new pharmacological agents and changing paradigms. J Thromb Haemost. 2013;11 Suppl 1:316-329.

12. Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes (review of technology appraisal guidance 182). National Institute for Health and Care Excellence; 2014. (www.nice.org.uk/guidance/ta317 Accessed 06/02/15).

13. Ticagrelor for the treatment of acute coronary syndromes. National Institute for Health and Care Excellence; 2011. (www.nice.org.uk/guidance/ta236 Accessed 06/02/15).

14. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. The New England Journal of Medicine. 2009;361(12):1139-1151.

15. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. The New England Journal of Medicine. 2011;365(11):981-992.

16. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. The New England Journal of Medicine. 2011;365(10):883-891.

17. Lockhart PB, Gibson J, Pond SH, Leitch J. Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease. Br Dent J. 2003;195(8):439-445.

18. McCormick NJ, Moore UJ, Meechan JG. Haemostasis. Part 1: The management of post-extraction haemorrhage. Dent Update. 2014;41(4):290-292, 294-296.

19. Joint Formulary Committee. British National Formulary. Vol 69. London: BMJ Group and Pharmaceutical Press; 2015.

20. Nematullah A, Alabousi A, Blanas N, Douketis JD, Sutherland SE. Dental surgery for patients on anticoagulant therapy with warfarin: a systematic review and meta-analysis. Journal of Canadian Dental Association. 2009;75(1):41.

21. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e326S-350S.

22. Armstrong MJ, Gronseth G, Anderson DC, et al. Summary of evidence-based guideline: periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(22):2065-2069.

23. Efient 5mg & 10mg film-coated tablets: Summary of Product Characteristics. Eli Lilly and Company Ltd, Daiichi Sankyo UK Limited; 2014. (www.medicines.org.uk/emc/medicine/21504. Accessed 06/02/15).

24. Brilique 90 mg film coated tablets: Summary of Product Characteristics. AstraZeneca UK Limited; 2014. (www.medicines.org.uk/emc/medicine/23935. Accessed 06/02/15).

25. Napenas JJ, Oost FC, DeGroot A, et al. Review of postoperative bleeding risk in dental patients on antiplatelet therapy. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2013;115(4):491-499.

26. Favaloro EJ, Lippi G. The new oral anticoagulants and the future of haemostasis laboratory testing. Biochemia Medica. 2012;22(3):329-341.

27. van Ryn J, Stangier J, Haertter S, et al. Dabigatran etexilate--a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost. 2010;103(6):1116-1127.

28. Baglin T, Keeling D, Kitchen S. Effects on routine coagulation screens and assessment of anticoagulant intensity in patients taking oral dabigatran or rivaroxaban: guidance from the British Committee for Standards in Haematology. Br J Haematol. 2012;159(4):427-429.

29. Xarelto 20mg film-coated tablets: Summary of Product Characteristics. Bayer plc; 2015. (www.medicines.org.uk/emc/medicine/25586. Accessed 06/02/15).

30. Eliquis 5mg film-coated tablets: Summary of Product Characteristics. Bristol-Myers Squibb-Pfizer; 2014. (www.medicines.org.uk/emc/medicine/27220. Accessed 06/02/15).

31. Pradaxa 150mg hard capsules: Summary of Product Characteristics. Boehringer Ingelheim Ltd; 2015. (www.medicines.org.uk/emc/medicine/24839. Accessed 06/02/15).

32. Greinacher A, Thiele T, Selleng K. Reversal of anticoagulants: an overview of current developments. Thromb Haemost. 2015;113(5).

33. Fragmin Graduated Syringe 10,000 IU/ml Solution for Injection: Summary of Product Characteristics. Pfizer Ltd; 2013. (www.medicines.org.uk/emc/medicine/26894. Accessed 06/02/15).

34. Clexane Forte Syringes: Summary of Product Characteristics. Sanofi; 2014. (www.medicines.org.uk/emc/medicine/10054. Accessed 06/02/15).

35. Innohep 10,000 IU/ml: Summary of Product Characteristics. Leo Laboratories Ltd; 2015. (www.medicines.org.uk/emc/medicine/29742. Accessed 06/02/15).

36. Clarkson JE, Ramsay CR, Eccles MP, et al. The translation research in a dental setting (TRiaDS) programme protocol. Implementation Science : IS. 2010;5:57.

37. Drug Prescribing For Dentistry, Second Edition, Scottish Dental Clinical Effectiveness Programme; 2011. ( http://www.sdcep.org.uk).
The Scottish Dental Clinical Effectiveness Programme (SDCEP) is an initiative of the National Dental Advisory Committee in partnership with NHS Education for Scotland. The Programme aims to provide user-friendly, evidence-based guidance on topics identified as priorities for oral health care.

SDCEP guidance aims to support improvements in patient care by bringing together, in a structured manner, the best available information that is relevant to the topic, and presenting this information in a form that can be interpreted easily and implemented.

‘Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs’ aims to provide clear and practical advice to enable the dental team to manage and treat this patient group. The guidance presents advice to inform the assessment of bleeding risk and decision making for treatment planning. Information about the newer anticoagulants and antiplatelet drugs as well as the more established medications is provided.

©Scottish Dental Clinical Effectiveness Programme

SDCEP operates within NHS Education for Scotland. You may copy or reproduce the information in this document for use within NHS Scotland and for non-commercial educational purposes.

Use of this document for commercial purposes is permitted only with written permission.

ISBN 978 1 905829 27 9

Scottish Dental Clinical Effectiveness Programme

Dundee Dental Education Centre, Frankland Building,

Small’s Wynd, Dundee DD1 4HN

Email scottishdental.cep@nes.scot.nhs.uk

Tel 01382 425751 / 425771

Website www.sdcep.org.uk



1 NOAC may also be used to represent Non-vitamin K antagonist Oral Anticoagulant. NOACs are also known as TSOACs for Target Specific Oral Anticoagulants and DOACs for Direct Oral Anticoagulants (DOAC is the term recommended by the International Society on Thrombosis and Haemostasis).

2 Some of these materials contain animal based protein which may not be acceptable to all patients, for ethical or religious reasons. Practices should ensure that non-animal based products are also available.
1   2   3   4   5   6   7   8   9


The database is protected by copyright ©dentisty.org 2016
send message

    Main page