Webinar: Caring for Women Dental Patients on Antithrombotic Medications

This is a recorded version of Caring for Women Dental Patients on Antithrombotic Medication. This program was presented by Dr. James Curtis, and was moderated by Dr. Rachel Rosovsky. It took place on November 16, 2023, and can be viewed at the bottom of this page.

Webinar Date: 11/16/2023
Estimated Time to complete: 1 hour
Format: Archived Webinar
Target Audience: Healthcare professionals in the clinical setting, including obstetricians, gynecologists, pediatric/adolescent gynecologists, hematologists, advanced practice providers, and nurses specializing in women’s health are the primary target audience in order to ensure optimal comprehensive care. An additional focus on dental care practitioners, including general dentists, dental surgeons, periodontists, and dental hygienists, who provide care to people with the ability to menstruate, or who had the ability to menstruate, as they may come into contact with patients who are receiving treatment with antithrombotic medications.

Background
Since the mid-1950s, vitamin K antagonists (VKA), such as Coumadin, have been the anticoagulants of choice for the treatment and prevention of arterial and venous thromboembolic events. Beginning in 2010, the U.S. Food and Drug Administration (FDA) approved the first direct oral anticoagulant (DOAC), dabigatran. Soon thereafter rivaroxaban, apixaban, edoxaban, and betrixaban were brought to market.

In the mid-1960s the precise mechanism by which aspirin inhibits platelet activation and aggregation was determined. Aspirin thus became the first effective antiplatelet drug. In late 1997, clopidogrel was introduced in the United States. Prasugrel and ticagrelor have subsequently been approved as antiplatelet medications.

The rapid adoption of DOACs has left the dental community to deal with evolving standards on how to safely provide care that induces bleeding for women dental patients who are taking DOACs. Additionally, newer antiplatelet medications and dual antiplatelet therapy (DAPT) create additional concerns for dentists who are performing dental procedures that cause bleeding.

Program Overview
This FWGBD Webinar, Caring for Women Dental Patients on Antithrombotic Medications, was presented by FWGBD Medical Advisory Board Member, Dr. James Curtis. Joined by moderator, Dr. Rachel Rosovsky, this webinar provides general and specific information regarding women taking anticoagulants and antiplatelet medications who are undergoing dental procedures that cause bleeding. Additionally, this discussion intends to provide medical practitioners information that will help them understand the level of bleeding caused by various dental procedures and the associated risks of oral bleeding.

Learning Objectives:

1. Describe general and specific information regarding women taking anticoagulants who are undergoing various dental procedures that cause bleeding.
2. Identify scientifically sound practice guidelines for managing women taking anticoagulants who require dental care that leads to bleeding.
3. Recognize the importance of communication between medical and dental professionals.

Moderator
Rachel Rosovsky, MD, MPH
Director, Thrombosis Research, Division of Hematology, MGH
Co-Chair, MGH Thrombosis Committee
Associate Professor of Medicine, Harvard Medical School

Presenting Faculty
James W. Curtis, Jr., DMD
Department of Dentistry
Prisma Health

Polling questions with correct answers:

1. Active bleeding following a routine dental extraction is usually controlled within 30 minutes.
2. Patient NOT taking any antithrombotics has advanced periodontitis and needs 29 teeth extracted. Blood loss may be up to 350  mL.
3. Patient taking warfarin 7.5 mg daily is considered safe for dental care causing moderate bleeding if INR day of procedure is less than or equal to 3.5.
4. Current literature recommends a patient scheduled for a deep cleaning and on apixaban 5 mg BID daily may continue medication or hold for 1 day.
5. Patient on ticagrelor monotherapy 90 mg BID, following PCl 10 months ago, should pause medication for 3-5 days before extractions.

---