Dental management of patients using antithrombotic drugs: critical appraisal of existing guidelines
Presented at the International Association for Dental Research Pan-European Federation conference, London, September 2008.
Received 5 November 2008; accepted 20 January 2009.
Objectives
The aims were: 1) to identify the guidelines available for management of dental invasive procedures in patients on antithrombotic drugs; 2) to assess their quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument; and 3) to summarize their conclusions and recommendations.
Study design
Systematic literature search for guidelines in several electronic databases. Retrieved guidelines were evaluated with the AGREE instrument for quality assessment.
Results
The systematic search yielded 93 results, of which only 4 were evidence-based practice guidelines. Two of these guidelines could be recommended for clinical use on the basis of the AGREE instrument. These 2 guidelines drew 68 conclusions from the existing literature and provided 58 recommendations.
Conclusions
Two evidence-based clinical practice guidelines, satisfactorily fulfilling the criteria of the AGREE instrument and both published in 2007, advise to not routinely discontinue antiplatelet and anticoagulation medication before dental surgery. The majority of the recommendations, however, were not sufficiently linked to levels of evidence.
aAssistant Professor and Director of Medicine, Clinic for Medical-Dental Interaction, Academic Center for Dentistry (ACTA), Amsterdam, The Netherlands
bAssistant Professor, Department of Social Dentistry and Behavioral Sciences, Academic Center for Dentistry (ACTA), Amsterdam, The Netherlands
cAssistant Professor, Department of Oral and Maxillofacial Surgery/Oral Pathology, Vrije Universiteit Medical Center/ACTA, Amsterdam, The Netherlands
dProfessor, Department of Social Dentistry and Behavioural Sciences, Academic Center for Dentistry (ACTA), Amsterdam, The Netherlands
eProfessor, Department of Oral and Maxillofacial Surgery/Oral Pathology, Vrije Universiteit Medical Center/ACTA, Amsterdam, The Netherlands
Reprint requests: Denise E. van Diermen, MD, Clinic for Medical-Dental Interaction, Academic Center for Dentistry Amsterdam (ACTA), Louwesweg 1, 1066 EA Amsterdam, The Netherlands
ABSTRACT