Supervisors info:
Καλύβας Δήμος, Αναπληρωτής Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Θεολόγη-Λυγιδάκη Κωνσταντίνα, Επίκουρη Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Κολόμβος Νικόλαος, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Summary:
For over 50 years the use of per os antithrombotic therapy in patients with cardiovascular diseases, for prevention of thromboembolic events, has significantly improved the quality and life expectancy of those patients. The major adverse effect of these medications in the increased risk of hemorrhage. The prevention and treatment of cardiovascular diseases requires a long-term use of antithrombotic medications and as a result the dentists are increasingly like to face these patients to perform surgical intervention such dental extraction. For the appropriate perioperative management of these patients, the hemorrhagic risk of the operation and the thromboembolic risk of the patient should carefully be assessed prior to any change of their antithrombotic medication.
The perioperative management in such cases constitutes a clinical dilemma for many surgical specialties, like the dentists, and makes the decision of how to manage these situations highly variable among many doctors. After literature review, there are specific guidelines from many scientific associations, which have high quality of evidence (systematic revies and metanalysis) and recommend how to treat these patients. Because tooth extraction is categorized as a low bleeding risk procedure according to the guidelines of the European Society of Cardiology (Steffel et al., 2018), it is suggested not to stop antiplatelet therapy or vit K antagonists and skip the last dose of NOACs to perform a simple tooth extraction in patients treated with antithrombotic medications. The dentist needs to know the basics of coagulation cascade, the pharmacokinetics of the antithrombotic medication and be able to assess the hemorrhagic risk of dental extraction and other dental surgical procedures to apply the latest guidelines.
In the current literature, there is a significant number of survey studies evaluating the dentist’s knowledge of perioperative management in patients taking antithrombotic medications in various countries. Unfortunately, there is no data available on this subject in Greece.
The purpose of this study is to:
• evaluate the knowledge of Greek dentists for the perioperative management of patients taking oral antithrombotic medications and
• to assess the possible correlation of the level of knowledge with the age, area of work and the possession or not of master’s degree.
Materials and methods: This study was based on self-filled questionnaires, which was shared as hand copies during the seminars of Society of Stomatology and as electronic copies via the Dental Association of Piraeus. 200 dentists filled the anonymous questionnaire, which was composed of 8 multiple choice questions and 2 filling the gap questions for the area of work and the possession or not of master’s degree.
Results: In the current study the percentage of the correct answers was fluctuated between 22.5% and 59,5%. As a result of that, it was estimated that most of the dentists correctly answered an average of 3 out of 7 questions regarding the perioperative management of patients under antithrombotic medications. Therefore, a usual answer that was noted, especially in situation in which the dentists were unable to make the right decision for the patients, was “according to the decision of patient’s cardiologist”. In most cases the cardiologist will interrupt the antithrombotic medication, in order to facilitate the dentist to perform the surgical procedure such as tooth extraction. This comes in contrary with the current guidelines and is really important to emphasize that the decision should be taken by both, physician and dentist, because the first should assess the thromboembolic risk of the patient and the latter should assess the bleeding risk of the procedure.
Conclusion: The level of knowledge of Greek dentists for the perioperative management of patients taking oral antithrombotic medications was found to be moderate to low in comparison with that of the dentists in other countries and because of the lack of knowledge of the guidelines in the current literature. It is really important for every dentist to follow the current guidelines of the literature and these guidelines should be easily accessible to the dentist of every country through each country’s dental association. Therefore, the continuous education plays a strategic role in understanding the risks of the unnecessary temporary interruption of the antithrombotic medication as this can have life threatening consequences in some patients.
Keywords:
Antithrombotic medication, Tooth extraction, Haemorrahgic risk, Thromboembolic risk, Guidelines
