Letter to the Editor
I just have two questions on the use of anticoagulants on dental patients.1 First, in the paragraph on managing risk it says:
Before undertaking any treatment, dentists must obtain a thorough medical history from the patient. This includes the name, dose and prescriber of all drugs.
Does the author really mean that the prescriber should be noted for each drug? I am wondering whether this is an error and perhaps was meant to be duration, or purpose? If not, for what reason should the prescriber be noted? This would be difficult information for many patients to provide accurately and difficult to substantiate for long-term therapy.
Second, there is no mention of the use of post-extraction tranexamic acid mouth rinse in this article. Despite strong support for its use after dental extractions in patients on warfarin, there are mixed opinions within the dental profession on the role of this mouthwash for patients on direct-acting oral anticoagulants.
Certainly, there is no evidence that it actually works and the absence of a proprietary product makes it difficult to support. However, many dental practitioners use it with the new oral anticoagulants just in case. A statement in the article on its role would have been helpful.
Senior clinical and drug information pharmacist
Mater Pharmacy Services
Adjunct associate professor
School of Pharmacy
University of Queensland
- Daly C. Treating patients on new anticoagulant drugs. Aust Prescr 2016;39:205-7.
- Sindet-Pedersen S, Ramström G, Bernvil S, Blombäck M. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. N Engl J Med 1989;320:840-3.
- Borea G, Montebugnoli L, Capuzzi P, Magelli C. Tranexamic acid as a mouthwash in anticoagulant-treated patients undergoing oral surgery. An alternative method to discontinuing anticoagulant therapy. Oral Surg Oral Med Oral Pathol 1993;75:29-31.
- Ramström G, Sindet-Pedersen S, Hall G, Blombäck M, Alander U. Prevention of postsurgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants. J Oral Maxillofac Surg 1993;51:1211-6.
- Scottish Dental Clinical Effectiveness Programme. Management of dental patients taking anticoagulants or antiplatelet drugs. Dental clinical guidance. Dundee: SDCEP; 2015. [cited 2017 Mar 1]
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