title: A study to assess management of patients on warfarin by general dental practitioners (GDPs) in the West Midlands.
abstract: Current management protocols for anticoagulated patients undergoing dental procedures are influenced by evidence-based guidelines. These guidelines state that the risk of significant bleeding is low in patients who have a stable INR within a therapeutic range, (2-4). The risks of interruption of anticoagulant therapy is greater than the risk of bleeding. This paper discusses the current practice of general dental practitioners (GDPs) in the West Midlands when treating patients taking warfarin and compares these findings with standard guidelines. A questionnaire was sent to 638 GDPs in West Midlands in 2010, 492 (77%) were returned. This study was carried out three years after a similar study carried out in South West Wales and after the guidance updated by the BNF and NMWIC. Thirty-three (7%) of the respondents did not treat patients on warfarin. The majority of respondents (86%) considered that a dental extraction in a patient on warfarin is a procedure associated with a high risk of bleeding. Surgical implant placement (75%), subgingival debridement (49%) and inferior dental block (40%) administration were also considered by GDPs to be associated with a high risk of bleeding.The majority (88%) of the respondents check the INR of anticoagulated patients before carrying out treatment. Of these, 244 (52%) would do so within 24 hours and 78 (17%) of them within 72 hours. Only 117 (25%) considered 4.0 as the safe upper limit for the INR for performing high-risk procedures.
  
  
  CONCLUSIONS
  The findings of this study demonstrate that there is general awareness about how to manage patients on warfarin but uncertainties still exist among general dental practitioners. Further education and training would improve the care of patients on warfarin in a primary care setting.
authors.affiliation: School of Dentistry, Birmingham Dental Hospital, St Chad's Queensway, Birmingham, UK.
authors.forename: Karun
authors.initials: K
authors.lastname: Dewan
authors.forename: Viren
authors.initials: V
authors.lastname: Vithlani
authors.forename: Neil
authors.initials: N
authors.lastname: Patel
authors.forename: Kathy
authors.initials: K
authors.lastname: Warren
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D017742:Dental Care for Chronically Ill; D004739:England; D005792:General Practice, Dental / Q000193:education; D019983:Guideline Adherence; D006801:Humans; D019934:International Normalized Ratio; D019647:Oral Surgical Procedures; D019239:Practice Patterns, Dentists'; D011795:Surveys and Questionnaires; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin