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References

SDCEP. Management of dental patients taking anticoagulants or antiplatelet drugs: dental clinical guidance. 2022. https://tinyurl.com/2p8exbak (accessed May 2022)
SDCEP. Post-treatment advice for dental patients taking anticoagulant or antiplatelet medication. 2022. https://tinyurl.com/wyka77f6 (accessed May 2022)
SDCEP. Pre-dental treatment instructions: direct oral anticoagulants (DOACs). 2022. https://tinyurl.com/94h3rb27 (accessed May 2022)
SDCEP. Management of dental patients taking anticoagulants or antiplatelet drugs: quick reference guide. https://tinyurl.com/yxk845pm (accessed May 2022)

Letters to the editor

From Volume 49, Issue 6, June 2022 | Page 520

Authors

Naomi Ayisire

Barts and The London School of Medicine and Dentistry, Faculty of Dentistry, Queen Mary University of London

Articles by Naomi Ayisire

Glenda Aruede

Oral Surgery Department, King's College Hospital, London

Articles by Glenda Aruede

Article

Plug in: updated guidance for the management of dental patients taking anticoagulants or antiplatelet drugs

In August 2015, the Scottish Dental Clinical Effectiveness Programme (SDCEP) published national guidance for the management of dental patients taking anticoagulants or antiplatelet drugs. Although most dental practitioners are aware of the established protocols for managing warfarin and antiplatelets, there is an increasing shift towards the use of direct oral anticoagulants (DOACs). This raises concern for the safe treatment of these patients due to the limited advice available, as practitioners will be faced with the challenge of managing potential bleeding complications following invasive dental procedures. Therefore, having national guidelines is essential as it will encourage the use of a consistent approach when encountering these patients.

The 2015 guidance was fully reviewed and recently replaced in March 2022, based on current evidence available.1 For warfarin and antiplatelet medication, the advice remains unchanged. It is important that dental practitioners are aware of the updated guidance and this letter draws attention to the key changes in the second edition:

  • Owing to some patients with Ehlers-Danlos syndrome exhibiting vascular fragility and platelet function abnormalities, this condition has been added to the main medical conditions associated with increased bleeding risk.
  • Patients undergoing cardioversion should not interrupt their anticoagulant or antiplatelet therapy without written instruction from their cardiologist.
  • Edoxaban is now a listed DOAC, and replicates the advice recommended for rivaroxaban.
  • Dental practitioners should be aware that in addition to the established post-treatment instruction sheets and to supplement their verbal instructions to the patient,2 there are now available new pre-treatment instruction sheets for patients.3 This is to ensure that patients are reminded of what is required of them prior to treatment, with the aim of preventing same-day cancellations and unnecessary travel.
  • SDCEP has expanded on the advice surrounding the use of low molecular weight heparins (LMWH). When encountering patients requiring dental treatment who are on a treatment dose of LMWH that is likely to cause bleeding, with either a low or higher risk of bleeding complications, it is recommended to consult their prescribing clinician for advice. However, for those taking prophylactic doses, the new key recommendation is to avoid interrupting their medication.

    • A succinct summary of the detailed guidance is available as a quick reference guide in an easily readable format for dental practitioners.4 With the diligent efforts of the SDCEP to provide clear guidance for dental care practitioners, the challenge of treating these patients becomes achievable.