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Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs

Blood-cellsPatients taking anticoagulants or antiplatelet drugs can have a higher risk of bleeding complications following invasive dental procedures. The newer oral anticoagulants and antiplatelet drugs available in the UK are being increasingly prescribed, and so more patients taking them are presenting for dental treatment.

New guidance from the Scottish Dental Clinical Effectiveness Programme (SDCEP), Management of Dental Patients Taking Anticoagulants and Antiplatelet Drugs, addresses the management of dental treatment for these patients. The need for current national guidance on this topic has arisen from concerns about the lack of clarity around current dental specific recommendations for the new drugs, and uncertainty about referral for these patients. This guidance aims to clarify the current recommendations and expert advice for the newer oral anticoagulants and antiplatelet drugs and presents these, along with up-to-date recommendations for the more established medications, within a single information resource.

Informing the Scoping of the Guidance

The scope of the guidance was informed by conducting telephone interviews with sixteen general dental practitioners (GDPs) from both rural and city practices from across Scotland. The aim was to identify current practice and factors which may influence the management of patients taking these drugs. The interviews also helped establish what dentists wanted from this guidance.

A patient questionnaire was developed to ensure that patients’ views are represented in the guidance. The questionnaire was distributed using two routes: (i) It was posted on three charity websites: Anticoagulation Europe; the Atrial Fibrillation Association; and The Stroke Association, and (ii) It was also distributed (face-to-face) through anticoagulation clinics in NHS Tayside with the help of colleagues from the Scottish Health Council. A summary report [accessible version] is available

Diagnostic Analysis

A diagnostic analysis comprises four stages: consultation feedback questionnaire; semi-structured telephone interviews; pre-guidance publication questionnaire; and post-guidance publication questionnaire:

1. Consultation feedback questionnaire

As part of SDCEP’s consultation process the draft guidance was circulated to organisational and individual stakeholders including GDPs for feedback. A number of questions focusing on the barriers and facilitators to implementation were included in the consultation feedback form.

2. Semi-structured telephone interviews

Dentists (GDPs) and dental hygienists (DHs) took part in interviews during the consultation period. Feedback gathered at consultation informed the interview questions which aim was to identify salient beliefs regarding the barriers and facilitators related to the implementation of the recommendations in the draft guidance.

3. Pre-guidance publication questionnaire

A questionnaire underpinned by the Theoretical Domains Framework was sent to a random sample of GDPs across Scotland six weeks prior to the publication and dissemination of the guidance. The content of the questionnaire was informed by the findings of the consultation feedback and the interviews.

Next Steps

4. Post-guidance publication questionnaire

A post-guidance questionnaire will be distributed six months after publication to identify any changes in practice following publication and dissemination of this SDCEP guidance.

Contact: Catalina Martin, tel: 01382 470955, e-mail: TRiaDS@nes.scot.nhs.uk