1376 JADA 142(12) http://jada.ada.org December 2011 RESEARCH U se of oral antithrombotic medications (OAMs) has been rising steadily in recent years owing, for the most part, to the high incidence of cardio- vascular diseases. 1 In the Nether- lands, aspirin was the second most-prescribed drug in 2009. 2 A sub- stantially smaller group of patients received treatment with vitamin K antagonists (VKAs) such as warfarin, acenocoumarol and phenprocoumon. 3 Pignone and colleagues 4 reported that 41 percent of the U.S. population older than 40 years was receiving treatment with antiplatelet medica- tions, and approximately 8 percent of U.S. patients had been receiving long-term VKA therapy. 5 Elderly patients tend to have more medically complex conditions than do younger patients and, there- fore, use different medications, including antithrombotic drugs. 6 As a result, general dentists and oral and maxillofacial surgeons likely are or will be treating patients receiving OAMs. This raises the question of Dr. van Diermen is an assistant professor, Department of Oral and Maxillofacial Surgery, Medical-Dental Interaction, Academic Center for Dentistry, Gustav Mahlerlaan 3004, room 12N41, 1081 LA Amsterdam, the Netherlands, e-mail “d.v.diermen@acta.nl”. Address reprint requests to Dr. van Diermen. Dr. Bruers is a research associate, Dutch Dental Asso- ciation, Nieuwegein, the Netherlands. Dr. Hoogstraten is a professor and head, Department of Social and Behavioral Sciences, Academic Center for Dentistry, Amsterdam. Ms. Bovenlander is a dental student, Faculty of Dentistry, Academic Center for Dentistry, Amsterdam. Ms. van den Bosch is a dental student, Faculty of Dentistry, Academic Center for Dentistry, Amsterdam. Dr. van der Waal is a professor, Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Amsterdam. Treating dental patients who use oral antithrombotic medication A survey of dentists in the Netherlands Denise E. van Diermen, MD; Josef J.M. Bruers, PhD; Johan Hoogstraten, PhD; Marieke Bovenlander, BSc; Albertine van den Bosch, BSc; Isaäc van der Waal, DDS, PhD ABSTRACT Background. For many years, international guidelines have advised health care professionals not to adjust oral antithrombotic medication (OAM) regimens before invasive dental pro- cedures. The authors conducted a study to examine the opinions of Dutch general dentists regarding the dental care of patients receiving treatment with these medications. Methods. The authors invited via e-mail 1,442 general dentists in the Netherlands to answer a 20-item Internet-based questionnaire that they developed. Survey items consisted of questions about medical history taking, number of patients in the dental practice receiving OAM therapy, frequency of consulting with medical and dental colleagues and suggested dental treatment of patients during various invasive dental procedures. Results. A total of 487 questionnaires were returned (response rate of 34 percent). The mean age of respondents was 47 years, and 77 percent were male. The majority of dentists responded that they obtain medical histories, but that they did not know how many of their patients were receiving OAM treatment. Dentists reported that they consult with medical colleagues frequently about antithrombotic medication. Ninety-one percent of respondents stated that they obtained their medical knowledge primarily in dental school. More than 50 percent of the dentists reported that they were not familiar with the international normalized ratio. The majority of dentists responded that they felt a need for clinical practice guidelines. Conclusions. According to the results of our survey, most dentists remain cautious when performing invasive dental procedures in patients who are treated with OAMs. Moreover, survey respondents tended to estimate that the risk of bleeding during dental procedures when OAM therapy is continued is higher than the risk of rethrom- bosis when use of antithrombotic medication is interrupted. Clinical Implications. A growing proportion of elderly patients and those with medically complex conditions are being treated in dental practices in the Netherlands. Consequently, more needs to be done to ensure that dentists are offered evidence-based guidance when treating patients who receive OAMs. Key Words. Anticoagulants; oral anticoagulant medication; acetylsalicylic acid; hemorrhage; medical history; practice guidelines. JADA 2011;142(12):1376-1382. J A D A C O N T I N U I N G E D U C A T I O N ✷ ✷  A R T I C L E 3 Copyright © 2011 American Dental Association. All rights reserved.