Key result
In a survey of 146 German dentists, 77.4% perform tooth extractions under continued aspirin therapy, whereas only 27.6% do so under continued vitamin-K-antagonist therapy.
Cross-Sectional (n=146)
A significant proportion of German dentists do not adhere to current recommendations for managing patients on antithrombotic therapy during dental procedures, highlighting a need for improved interdisciplinary education.
OBJECTIVE: To investigate how German dentists adhere to recommendations regarding dental treatment of patients taking antiplatelet or oral anticoagulation therapy for cardiovascular protection. BACKGROUND: Discontinuation of antiplatelet or oral anticoagulation therapy prior to dental procedures is usually not recommended because the risk of thromboembolic events is higher than that of significant procedure-related bleeding. MATERIALS AND METHODS: An anonymous questionnaire regarding the handling of and experiences with patients taking aspirin (acetylsalicylic acid) or vitamin-K-antagonists (phenprocoumon) was distributed to approximately 4500 dentists attending the national German Dentists Day 2011. RESULTS: Of 146 dentists who completed the questionnaire 77.4% and 27.6% stated that they perform tooth extractions under continued therapy with aspirin or vitamin-K-antagonists, respectively. When asked regarding the INR or Quick values, they require for tooth extractions in patients taking oral anticoagulants 29.5% of the dentists provided values that were outside the safe range (INR ≤1.5 or ≥3.5) and 90.7% accepted values too old to be clinically reliable. For pain relief after dental procedures, 71.2% of the dentists recommended ibuprofen notwithstanding the fact that it attenuates protective effects of aspirin and 10.2% would discontinue aspirin and prescribe ibuprofen or paracetamol (acetaminophen). CONCLUSION: Despite similar recommendations the majority of dentists perform tooth extractions in patients taking aspirin but not in patients taking vitamin-K-antagonists. Moreover, a potentially unfavourable drug interaction of aspirin and ibuprofen is frequently not considered. In patients taking vitamin-K-antagonists too many dentists rely on laboratory values that are too old or outside the recommended range.
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Ringel et al. (2015) conducted a cross-sectional in Dental treatment of patients taking antiplatelet or oral anticoagulation therapy (n=146). Patients taking aspirin vs. Patients taking vitamin-K-antagonists was evaluated on Performance of tooth extractions under continued therapy. In a survey of 146 German dentists, 77.4% perform tooth extractions under continued aspirin therapy, whereas only 27.6% do so under continued vitamin-K-antagonist therapy.
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