The treatment of patients taking anticoagulant or antiplatelet medication can cause concern in terms of the potential risk of bleeding complications following invasive dental procedures.
The anticoagulant warfarin, and antiplatelet agents aspirin and clopidogrel, have been widely used for
many years and most dental practitioners will be familiar with well-established guidelines for the dental care of patients taking these drugs.
Several other oral anticoagulants (the DOACs or Direct Oral Anticoagulants; namely apixaban, dabigatran, rivaroxaban and edoxaban) and antiplatelet drugs (prasugrel and ticagrelor) have become available in the UK since 2008 and their use (particularly the DOACs) has become increasingly common.
Limited evidence in the context of dentistry to inform the treatment of patients taking these newer drugs has led to variation in advice for the appropriate management of these patients.
There has also been a lack of advice about treating dental patients taking the less commonly encountered injectable low molecular weight heparins (LMWHs).
This guidance aims to encourage a consistent approach to the management of dental treatment for patients who are taking anticoagulants or antiplatelet drugs by providing recommendations and advice relevant to dental treatment, based on research evidence and expert opinion.
This second edition of the guidance comprises an update following a full review of the 2015 first edition, in the context of the current evidence (see Appendix 1).
The recommendations from the first edition of the guidance are largely unchanged.
The main changes in this edition are:
• Inclusion of new information on the prevalence of anticoagulant use and the availability of reversal agents (Section 2);
• The DOAC key recommendations amended to apply to patients taking edoxaban, with
further information and advice provided (Section 5);
• Inclusion of a new key recommendation and expanded advice for the management of patients taking low molecular weight heparins (Section 7);
• Updates to the evidence and basis for the key recommendations (Sections 5-8);
• Updates to the tables (Section 3) and appendices.
