Dental patients taking anticoagulants

The Scottish Dental Clinical Effectiveness Programme (SDCEP) has just launched its latest guidance on the Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs. The aim of the document is to clarify the current recommendations and expert advice for the newer oral anticoagulants and antiplatelet drugs and presents these, along with up-to-date recommendations for the more established medications, within a single widely available information resource.

The guidance was developed by a multidisciplinary guidance development group including medical and dental practitioners and specialists and a patient representative. Development of the recommendations followed the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.

A number of guidance resources have been produced by the group; a full guidance document, quick reference guide and supporting tools. The full guidance document contains sections on:-

Anticoagulant and antiplatelet drugs
Assessing bleeding risk
Managing bleeding risk
Treating a patient taking warfarin or another vitamin K antagonist
Treating a patient on antiplatelet drug(s)
Treating a patient taking a novel oral anticoagulant (NOACs)
Treating a patient taking an injectable anticoagulant
Drug interactions between anticoagulants or antiplatelet drugs and other medications.

The quick reference guide includes a management flow chart with links to the relevant sections of the full guidance document. The supporting tools consist of a range of patient information letters and post treatment advice sheets

Comments

The risk of bleeding complications for those dental patients taking anticoagulants or antiplatelet medication is of concern. Warfarin and the antiplatelet agents aspirin and clopidogrel have been in use for many years and have well-established guidance in place. However the increasing use of newer anticoagulants such as apixaban, dabigatran and rivaroxaban and antiplatelet drugs, prasugrel and ticagrelor means that advice on the management of these patients is welcome.

As with other guidance documents from SDCEP a well structured approach has been taken to the development of these guidelines using the GRADE approach. The layout of the documents is clear with actions and key recommendations being clearly highlighted in the text. The patient information leaflets available for each category of drug will also be very helpful. For those working in Scotland there will also be two educational events in October to support the publication.