VIEWS OF CARDIAC-VALVE PROSTHESIS PATIENTS AND THEIR DENTISTS ON ANTICOAGULATION THERAPY

By administering a questionnaire to 253 patients with cardiac-valve pr ostheses (89.3% responding), and another to 136 of their attending den tists (79% responding), the level of knowledge among both groups of an ticoagulant therapy in connection with dental treatment was investigat ed. The cardiothoracic department monitored all anticoagulation therap ies. Of the anticoagulated patients, 96.6% were able to state their me dication (94.1% received phenprocoumon); and of 86 dentists with patie nts on anticoagulation treatment, 94% were aware of their patients' me dication. All 20 dentists stating that their patients did not receive anticoagulants were correct. The great majority (98%) of the dentists employed a special measure to reduce the risk of bleeding associated w ith invasive dental procedures, most commonly (86%) referring patients to their general practitioner or hospital department for adjustment o f the anticoagulant therapy. Around 60% of the dentists considered ext ractions and operations to require measures to reduce the risk of blee ding complications. We recommend referral of patients to the attending physician for adjustment of anticoagulation to a target International Normalized Ratio (INR) of 4.0 or possibly 3.0 before undergoing denta l procedures involving the risk of bleeding. Additional reduction of t he bleeding risk can be obtained by local application of an inhibitor of fibrinolysis (tranexamic acid).