Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs



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Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs

Quick Reference Guide



For further details please refer to the full

guidance, available at www.sdcep.org.uk

August 2015

Table 1 Post-operative bleeding risk for dental proceduresthis flowchart provides a summary of the key recommendations and advice from the guidance. included are options for patient management decisions, general advice for managing bleeding risk and drug group specific recommendations and advice. all of the information contained in the flowchart can be found in the summary of recommendations in the full guidance (available at www.sdcep.org.uk).

Dental procedures that are unlikely to cause bleeding

Dental procedures that are likely to cause bleeding

Low risk of post-operative bleeding complications


Higher risk of post-

operative bleeding complications




Local anaesthesia by infiltration, intraligamentary or mental nerve block

Local anaesthesia by inferior dental block or other regional nerve blocks

Basic periodontal examination (BPE)

Supragingival removal of plaque, calculus and stain

Direct or indirect restorations with supragingival margins

Endodontics - orthograde

Impressions and other prosthetics procedures

Fittings and adjustment of orthodontic appliances




Simple extractions (1-3 teeth, with restricted wound size)

Incision and drainage of intra-oral swellings

Detailed six point full periodontal examination

Root surface instrumentation (RSI) and subgingival scaling

Direct or indirect restorations with

subgingival margins



Complex extractions, adjacent extractions that will cause a large wound or more than 3 extractions at once

Flap raising procedures:

Elective surgical extractions

Periodontal surgery

Preprosthetic surgery

Periradicular surgery

Crown lengthening

Dental implant surgery

Gingival recontouring

Biopsies


There is no evidence to suggest that an inferior dental block performed on an anticoagulated patient poses a significant risk of bleeding.

Table 1 categorises dental procedures according to the risk of post-operative bleeding complications. This table should be used as part of the assessment of bleeding risk for the patient, to inform patient management and treatment planning guided by the flowchart.



NOAC dose schedules for dental procedures with a higher risk of bleeding complications.


NOAC


Usual drug

schedule


Morning dose

(pre-treatment)


Post-treatment dose

apixaban or dabigatran



Twice a day


Miss morning dose


Usual time in evening


rivaroxaban


Once a day; morning


Delay morning dose


4 hours after haemostasis has been achieved



rivaroxaban


Once a day; evening


Not applicable


Usual time in evening




As long as no earlier than 4 hours after haemostasis has been achieved.

The patient should continue with their usual drug schedule thereafter.

This Quick Reference Guide aims to provide dental professionals with a convenient aid to decision making for the management of patients taking anticoagulants or antiplatelet drugs.

The information provided within this guide is extracted from the Scottish Dental Clinical Effectiveness Programme (SDCEP) ‘Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs’ guidance and is not comprehensive. The user should refer to the guidance for a full explanation of the recommendations, the basis for them, and for other points that should be considered when managing these patients.

The full guidance is available at www.sdcep.org.uk.



Scottish Dental Clinical Effectiveness Programme

Dundee Dental Education Centre, Frankland Building,

Small’s Wynd, Dundee DD1 4HN

Email scottishdental.cep@nes.scot.nhs.uk



Tel 01382 425751 / 425771

Website www.sdcep.org.uk


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