Knowledge and Practice of Dentists Managing Patients on Antithrombotic Medications: A Cross-Sectional Survey

Abstract

Objectives In this article, we explored the level of knowledge and practice of licensed dentists in the United Arab Emirates regarding managing patients on antithrombotic medications. Moreover, to assess the need for educational intervention in this area is one of the objectives.

Materials and Methods A total of 502 dentists answered 22 close-ended questionnaires. The sample size was determined based on the registry of the Ministry of Health.

Results Only 5.6 and 5.9% showed satisfactory overall awareness about aspirin and plavix, respectively, as drugs may hamper hemostasis. A substantial proportion of dentists consider aspirin (63.1%) and clopidogrel (52.2%) discontinuation before treatment. More than one-third of the participants shall not consider extracting teeth before physician approval, and one-quarter to one-third of them refer patients on such medications to oral surgeons to perform tooth extraction. Most respondents did not adequately answer the questions about the additional hemostatic measures and postoperative analgesia. A significantly high number of participants (n = 440, 87.6%) want to attend updated courses on the dental management of such patients.

Conclusions The dentists demonstrate a contrasting diversity of knowledge and practice approaches to patient management on antiplatelet agents. There is an apparent demand to raise understanding of the evidence-based management of a patient on such medications. It is vital to keep formalized training sessions and provide the necessary expertise to students and dentists to prevent unwanted complications.

Keywords

dental practice - antiplatelet - antithrombotics - knowledge - aspirin - clopidogrel

Ethical Approval and Consent to Participate

This study was reviewed and approved by the Research Ethical Committee of Ajman University (SS1–18112013). Written informed consent was obtained from all participants.

Publication History

Article published online:
11 January 2022

• References

• 1 Little J, Falace D, Miller C. eds. Dental Management of the Medically Compromised Patient. 7th ed.. St Louis, MO: Mosby Elsevier; 2008: 396-432
• 2 Robati R, Farokhi M. Evaluation the dentists' awareness of inherited bleeding disorders and anticoagulants in Shiraz. Iran J Ped Hematol Oncol 2013; 3 (04) 159-163
• 3 Pototski M, Amenábar JM. Dental management of patients receiving anticoagulation or antiplatelet treatment. J Oral Sci 2007; 49 (04) 253-258
• 4 Hirsh J. Antithrombotic therapy. ASH 2008; 3 (01) 28-31
• 5 Salehi MR. Evaluation the knowledge and application of Isfahan dentists about coagulation tests in patients with coagulation disorders. Majallah-i Danishkadah-i Dandanpizishki-i Isfahan 2006; 2 (01) 59-62
• 6 Collet JP, Montalescot G, Blanchet B. et al. Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes. Circulation 2004; 110 (16) 2361-2367
• 7 Ferrari E, Benhamou M, Cerboni P, Marcel B. Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. J Am Coll Cardiol 2005; 45 (03) 456-459
• 8 Linnebur SA, Ellis SL, Astroth JD. Educational practices regarding anticoagulation and dental procedures in U.S. dental schools. J Dent Educ 2007; 71 (02) 296-303
• 9 Iqbal A, Glenny AM. General dental practitioners' knowledge of and attitudes towards evidence based practice. Br Dent J 2002; 193 (10) 587-591 , discussion 583
• 10 Rabe P, Holmén A, Sjögren P. Attitudes, awareness and perceptions on evidence based dentistry and scientific publications among dental professionals in the county of Halland, Sweden: a questionnaire survey. Swed Dent J 2007; 31 (03) 113-120
• 11 Gibson J, Jack K, Rennie JS. Computer literacy, skills and knowledge among dentists and dental care professionals (DCPs) within primary care in Scotland. Inform Prim Care 2006; 14 (01) 17-28
• 12 Al-Maweri SA, Alshammari MN, Alharbi AR. et al. Knowledge and opinions of saudi dentists regarding dental treatment of patients undergoing bisphosphonates. Eur J Dent 2020; 14 (01) 144-151
• 13 Boccio E, Hultz K, Wong AH. Topical tranexamic acid for hemostasis of an oral bleed in a patient on a direct oral anticoagulant. Clin Pract Cases Emerg Med 2020; 4 (02) 146-149
• 14 Abraham SB, Amini AMA, Khorshed NE, Awad M. Quality of life of dentists. Eur J Dent 2018; 12 (01) 111-115
• 15 Dell RB, Holleran S, Ramakrishnan R. Sample size determination. ILAR J 2002; 43 (04) 207-213
• 16 Murphy J, Twohig E, McWilliams SR. Dentists' approach to patients on anti-platelet agents and warfarin: a survey of practice. J Ir Dent Assoc 2010; 56 (01) 28-31
• 17 Can MM, Biteker M, Babur G, Ozveren O, Serebruany VL. Knowledge, attitude and perception of antiplatelet therapy among dentists in Central Eastern Turkey. World J Cardiol 2012; 4 (07) 226-230
• 18 de Vasconcellos SJ, de Santana Santos T, Reinheimer DM, Faria-E-Silva AL, de Melo MF, Martins-Filho PR. Topical application of tranexamic acid in anticoagulated patients undergoing minor oral surgery: a systematic review and meta-analysis of randomized clinical trials. J Craniomaxillofac Surg 2017; 45 (01) 20-26
• 19 Mahmood H, Siddique I, McKechnie A. Antiplatelet drugs: a review of pharmacology and the perioperative management of patients in oral and maxillofacial surgery. Ann R Coll Surg Engl 2020; 102 (01) 9-13
• 20 Aframian DJ, Lalla RV, Peterson DE. Management of dental patients taking common hemostasis-altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103 (Suppl): 45.e1-45.e11
• 21 Villanueva J, Salazar J, Alarcón A. et al. Antiplatelet therapy in patients undergoing oral surgery: a systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2019; 24 (01) e103-e113
• 22 Sáez-Alcaide LM, Sola-Martín C, Molinero-Mourelle P, Paredes-Rodríguez V, Zarrias-Caballero C, Hernández-Vallejo G. Dental management in patients with antiplatelet therapy: a systematic review. J Clin Exp Dent 2017; 9 (08) e1044-e1050