General dentists' approach to dental management of patients taking anticoagulants: a national survey-based assessment: pre- and post-procedure practice.

AIM: To determine the pre-operative and post-operative practices of general dentists (GDs) in the community for patients taking vitamin K antagonists (VKA) and direct oral anti-coagulants (DOACs).

METHODS

An online questionnaire was administered to GD members of the National Dental Practice-Based Research Network. GDs were queried about the interaction with the medical professional prior to dental treatment, use of laboratory tests to assess bleeding risk, measures to control bleeding, and comfort level with delivering dental care.

RESULTS

A total of 47.6% and 41.2% of GDs "always" consult with the patient's physician prior to an extraction in a patient on VKA or DOACs, respectively. 27.1% and 8.7% of GDs use laboratory tests to assess risk for bleeding prior to a dental extraction in patients on VKA and DOAC, respectively. For VKA patients, GDs prefer INR testing (68.4%), and for DOAC patients, most GDs are "unsure" what blood test to use. The most-used hemostatic agents were cellulose (65.1%), collagen (60.6%) and epinephrine infiltration (60.6%).

CONCLUSIONS

GDs are uncertain about the best approach for patients taking DOACs. INR is not routinely used by most GDs to assess the bleeding risk in patients taking VKA. The most commonly used hemostatic agents are cellulose-based, collagen-based and vasoconstrictors.