Background to the guidance

The treatment of patients taking anticoagulant or antiplatelet medication can cause concern in terms of the potential risk of bleeding complications following invasive dental procedures.

The anticoagulant warfarin, and antiplatelet agents aspirin and clopidogrel, have been widely used for many years and most dental practitioners will be familiar with well-established guidelines for the dental care of patients taking these drugs.

Several other oral anticoagulants (the DOACs* or Direct Oral Anticoagulants; namely apixaban, dabigatran, rivaroxaban and edoxaban) and antiplatelet drugs (prasugrel and ticagrelor) have become available in the UK since 2008 and their use (particularly the DOACs) has become increasingly common.

Limited evidence in the context of dentistry to inform the treatment of patients taking these newer drugs has led to variation in advice for the appropriate management of these patients. There has also been a lack of advice about treating dental patients taking the less commonly encountered injectable low molecular weight heparins (LMWHs).

This guidance aims to encourage a consistent approach to the management of dental treatment for patients who are taking anticoagulants or antiplatelet drugs by providing recommendations and advice relevant to dental treatment, based on research evidence and expert opinion.

* DOACs (Direct Oral Anticoagulants) are also known as NOACs (Novel Oral Anticoagulants or Non-vitamin K antagonist Oral Anticoagulants), or as TSOACs (Target Specific Oral Anticoagulants). The term DOAC has been adopted for the second edition of the guidance, rather than NOAC as previously, to reflect the more widely accepted usage of DOAC across healthcare professions.