Lane DA, Lip GYH. Use of the CHA2DS2-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation. 2012; 126:860-865
Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007; 146
Keeling D, Tait RC, Watson H. Peri-operative management of anticoagulation and antiplatelet therapy. Br J Haematol. 2016; 175:602-613
Keeling D, Baglin T, Tait C Guidelines on oral anticoagulation with warfarin – 4th edition. Br J Haematol. 2011; 154:311-324
Raja AS, Greenberg JO, Qaseem A Evaluation of patients with suspected acute pulmonary embolism: best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2015; 163:701-711
Lim W, Le Gal G, Bates SM American Society of Haematology 2018 Guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv. 2018; 2
Konstantinides SV, Meyer G, Becattini C ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019; 54
Kearon C, Akl EA, Ornelas J Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016; 149
Antithrombotic therapy for prosthetic heart valves: management of bleeding and invasive procedures. 2019. https://tinyurl.com/yya9bpam (accessed November 2020)
HAS-BLED tool – what is the real risk of bleeding in anticoagulation?. 2012. https://tinyurl.com/y3s46zl8 (accessed November 2020)
Lip GY, Frison L, Halperin JL, Lane D. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation. The HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly, drugs/alcohol concomitantly) score. J Am Coll Cardiol. 2011; 57:173-180
Camm AJ, Lip GY, De Caterina R Focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fbrillation. Eur Heart J. 2012; 33:2719-2747
Perry DJ, Noakes TJ, Helliwell PS. Guidelines for the management of patients on oral anticoagulants requiring dental surgery. Br Dent J. 2007; 203:389-393
Heidbuchel H, Verhamme P, Alings M Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary. Eur Heart J. 2017; 38:2137-2149
Nathwani S, Wanis C. Novel oral anticoagulants and exodontia: the evidence. Br Dent J. 2017; 222:623-628
Connolly SJ, Ezekowitz MD, Yusuf S RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361:1139-1151
Schulman S, Kearon C, Kakkar AK RE-COVER Study Group. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009; 361:2342-2352
Steffel J, Verhamme P, Potpara T The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018; 39:1330-1393
Patel MR, Mahaffey KW, Garg J ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365:883-891
Bauersachs R, Berkowitz SD Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010; 363:2499-2510
Granger CB, Alexander JH, McMurray JJ ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365:981-992
Büller HR, Décousus H Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013; 369:1406-1415
Gomez-Moreno G, Aguilar-Salvatierra A, Fernandez-Cejas E Dental implant surgery in patients in treatment with the anticoagulant oral rivaroxaban. Clin Oral Impl Res. 2016; 27:730-733 https://doi.org/10.1111/clr.12653
Clemm R, Neukam F W, Rusche B Management of anticoagulated patients in implant therapy: a clinical comparative study. Clin Oral Implan Res. 2015; 27:1274-1282
Mauprivez C, Khonsari RH, Razouk O Management of dental extraction in patients undergoing anticoagulant oral direct treatment – a pilot study. Oral Surg Oral Med Oral Path Oral Radiol. 2016; 122:e146-e155
Brennan Y, Schifter M, Crowther H Dental extractions on direct oral anticoagulants vs. warfarin: the DENTST study. Res Pract Thromb Haemost. 2020; 4:278-284
Brennan Y, Favaloro EJ, Curnow J. To maintain or cease non-vitamin K antagonist oral anticoagulants prior to minimal bleeding risk procedures: a review of evidence and recommendations. Semin Thromb Hemost. 2019; 45:171-179
Yoshikawa H, Yoshida M, Yasaka M Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study. Int J Oral Maxillofac Surg. 2019; 48:1102-1108
Berton F, Costantidines F, Rizzo R Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study. Clin Oral Investig. 2019; 23:3183-3192
Caliskan M, Tükel HC, Benlidayi ME, Deniz A. Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants?. Med Oral Patol Oral Cir Bucal. 2017; 22:e767-e773
Lababidi E, Breik O, Savage J Assessing an oral surgery specific protocol for patients on direct oral anticoagulants: a retrospective controlled cohort study. Int J Oral Maxillofac Surg. 2018; 47:940-946
The UK has an increasingly ageing population and, inevitably, the prevalence of anticoagulation among dental patients will grow. This same group of patients are retaining their natural teeth longer and will potentially require dental treatment and oral surgical procedures and so, general dental practitioners will need to be aware of the implications of anticoagulant drugs. Equally, to comply with requirements set by the General Dental Council's ‘Standards for the Dental Team’ it is imperative to ensure that, as clinicians, we put patients' interests first, and provide quality care based on current evidence.
CPD/Clinical Relevance: It is important that dentists have knowledge and expertise to consult and treat medically compromised patients for patient safety and to adhere to best practice guidelines.
Article
In October 2019, a general dental practitioner (GDP) was suspended for 12 months following a Professional Conduct Committee (PCC) hearing at the General Dental Council (GDC).1 It was found that the GDP's fitness to practise was impaired due to misconduct that led to the death of patient A. It was deemed that there were a number of crucial omissions, which were repeated on more than one occasion, during the five treatment episodes (including extractions and denture construction) between 5 June and 18 July 2017.
The patient had been attending the practice for treatment, where it was known to the GDP that the patient was on warfarin for thrombotic thrombocytopenic purpura (TTP) as per the completed medical history form. On 13 June 2017, at 11:20 am, the UR6, UR5, UR3, LR1 and LL1 were extracted and impressions taken to construct dentures. On 18 July 2017, at 15:15 pm, the UR2, UR1, UL1, UL2 and UL3 were extracted and both an upper complete and lower partial denture fitted.
Register now to continue reading
Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:
