Literature reviews: Patient-centred care

Abstract

embolism in atrial fibrillation and treatment of thrombo-embolic disease. Although dabigatran is associated with less serious bleeding than warfarin,1 life-threatening bleeding events can still occur. The SDCEP have attempted to create a guideline for dental surgeons to help manage patients on NOACs prior to low or high risk surgery on the basis of low quality evidence. However, these guidelines were largely conservative, encouraging patients to continue taking dabigatran for low risk surgeries and omit a dose for high risk surgeries. Recent evidence regarding the efficacy of iduracizumab, a reversal agent for dabigatran, has stimulated debate as to its usefulness. A phase 1 trial initially showed the drug was able to reverse the effects of dabigatran with limited side effects.2 This was followed by the phase 3 RE-VERSE AD trial3 which demonstrated iduracizumab’s ability to normalise clotting time in 88-98% of participants taking dabigatran prior to urgent surgery. Since this trial several case reports4–6 have matched the same results with safe instant reversal of dabigatran, as the ongoing REVERSE-AD trial7 continues to show promising, similar results. As the medication is still largely novel, the trials regarding efficacy and long-term risks are ongoing. However, current evidence suggests iduracizumab is a safe and efficacious method of dabigatran reversal with further research required. S. J. Chandan, T. Thomas, S. H. Baryah, by email

DOI: 10.1038/sj.bdj.2017.98

Cite this paper

@article{Yeung2017LiteratureRP, title={Literature reviews: Patient-centred care}, author={C Albert Yeung}, journal={BDJ}, year={2017}, volume={222}, pages={141-142} }