Background: Dabigatran is a direct thrombin inhibitor. It is a novel anticoagulant that has been introduced into the market. It is orally administered, has predictable pharmacokinetics and dose response, and does not require monitoring. The use of dabigatran will likely increase in the coming years, and so it is important for oral and maxillofacial surgeons to be aware of its mechanism of action, the possible complications, and strategies to reverse the bleeding if it occurs. We conducted a retrospective study to develop a protocol to safely manage these patients in a hospital extraction clinic setting.

Methods:  A retrospective review of charts of patients taking dabigatran who underwent extractions at the Adelaide Oral and Maxillofacial Unit was conducted from Jan 2013 till December 2013. 8 patients were identified. Patient demographics, medical history, procedure and complications were collected.

Results:  Out of the 10 included patients, 5 underwent single extractions and 3 underwent multiple extractions in the same appointment. All the patients who underwent single extractions while continuing dabigatran had no post-operative bleeding. Amongst the 3 patients who underwent extraction of multiple teeth, 2 had ceased the dabigatran at least 24 hours pre-operatively and these patients did not have any post-operative bleeding. 1 patient underwent extraction of 18 teeth while continuing dabigatran, and this patient had a significant post-operative bleed necessitating a return to theatre.

Conclusion: Continuing dabigatran for patients undergoing single extractions is safe if local haemostatic measures are employed. When undergoing multiple extractions, the surgeon may consider ceasing the dabigatran for 24 hours to avoid post-operative bleeding. Strategies for managing the emergency patient on dabigatran have also been discussed and included in the protocol.