Dual anti-platelet therapy and dento-alveolar surgery. How do we manage patients on anti-platelet medication?

• Published in: British dental journal Vol. 217; no. 11; p. E24
• Main Authors: Patel, N., Patel, V., Sarkar, D., Nokes, T., Blacklock, P.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05-12-2014; Nature Publishing Group
• Subjects: 692/700/3032/3099/3111/3114; 692/700/565/1436; Acute coronary syndromes; Adenosine; Aspirin; Blood platelets; Cardiovascular disease; Dental Care for Chronically Ill; Dentistry; Disease prevention; Drug Therapy, Combination; Female; Humans; Male; Maxillofacial surgery; Medicine; Oral Surgical Procedures; Platelet Aggregation Inhibitors - therapeutic use; Practice Patterns, Dentists; Questionnaires; Stroke; Surveys and Questionnaires; United Kingdom
• ISSN: 0007-0610; 1476-5373
• DOI: 10.1038/sj.bdj.2014.1055

Key Points
Explains the uses of anti-platelet drugs.
Reports variation in the practice of managing these patients.
Suggests there is no high quality evidence on how to best manage patients taking dual anti-platelet medication undergoing dentoalveolar surgery.
Objective
The optimum management of dual anti-platelet therapy (DAPT) in patients undergoing dentoalveolar surgery is controversial. The lack of guidelines has meant clinicians have been left to manage these cases from specialist advice or past experience. In view of this the British Association of Oral Surgeons (BAOS) membership was surveyed to assess current practice.
Design
An electronic survey consisting of nine closed multiple-choice questions was circulated to all 435 registered BAOS members. A section for open comments was also included. The data was transcribed, organised and reduced to themes by hand and finally analysed.
Results
One hundred and eighty members completed the questionnaire giving a response rate of 41%. Ninety-two percent of clinicians had direct involvement in managing patients on DAPT and of these 80% had not encountered a bleeding complication. DAPT was continued for simple dental extraction under local anaesthetic by 83% of respondents and 73% for surgical extractions. Two thirds of the respondents did not follow any guidelines but for those that did the most common was the UK Medicines Information protocols. Only 10% of respondents reported a significant post-operative bleeding complication following surgery in patients on DAPT.
Conclusion
This survey confirmed the continued variable management of patients on DAPT undergoing dentoalveolar surgery. Reported bleeding rates were low with over 75% of patients not having their DAPT treatment interrupted.