Dental management of patients using antithrombotic drugs: critical appraisal of existing guidelines.
OBJECTIVE
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.


METHODS
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.
Clinic for Medical-Dental Interaction, Academic Center for Dentistry (ACTA), Amsterdam, The Netherlands. d.v.diermen@acta.nl
Denise E
DE
van Diermen
Irene H A
IH
Aartman
Jacques A
JA
Baart
Johan
J
Hoogstraten
Isaäc
I
van der Waal
D000766:Anesthesia, Dental / Q000379:methods; D000772:Anesthesia, Local / Q000379:methods; D019072:Antibiotic Prophylaxis; D017742:Dental Care for Chronically Ill; D055094:Evidence-Based Dentistry; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D019934:International Normalized Ratio; D019647:Oral Surgical Procedures; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D017410:Practice Guidelines as Topic / Q000592:standards*; D011300:Preoperative Care; D011785:Quality Assurance, Health Care; D012015:Reference Standards; D012017:Referral and Consultation
D005343:Fibrinolytic Agents