Dewan K, Bishop K, Muthukrishnan A
Registrar in Restorative Dentistry, The School of Dentistry, University of Birmingham, St Chad's Queensway, Birmingham, B4 6NN.
Br Dent J. 2009 Feb 28;206(4):E8; discussion 214-5. doi: 10.1038/sj.bdj.2009.112. Epub 2009 Feb 13.
To ascertain the current management protocols of patients on warfarin by general dental practitioners (GDPs) in South West Wales and to compare these findings with current guidelines and the results from a previous audit published in 2003.
A questionnaire similar to that used in the first audit was sent to 447 GDPs in South West Wales. In addition, questions were included on factors which might affect international normalised ratio (INR), the timing of pre-operative INR assessment and the risk of bleeding associated with implant surgery. GDPs' details were derived from the online GDC database of registered dental practitioners. Registered specialists and GDPs who practised only orthodontics were excluded.
Of the 447 questionnaires distributed, 332 (74%) were returned. Eight percent (n = 26) of the respondents did not treat patients on warfarin. Two hundred and forty-seven respondents (74%) considered implant placement as a procedure with high risk of bleeding, with inferior dental block, sub-gingival restorations and sub-gingival debridement receiving a lower response (45%, 28% and 12%, respectively). When planning a high risk procedure, 206 respondents (63%) indicated they would seek advice from a cardiologist or general medical practitioner; none of the respondents would advise the patient to reduce their warfarin dose, while 1% indicated they would ask the patient to stop taking warfarin without seeking any medical opinion. A total of 278 respondents (84%) stated they would check the INR before treatment and of these, 214 (65%) indicated they would do so within 24 hours of treatment and 60 (18%) within 48 hours. Ten respondents said they would not normally check INR. One hundred and twelve respondents (34%) considered 2.5 as the safe upper INR limit for performing high risk procedures, 21 (6%) considered an INR of between 1 and 2 as the safe limit, 99 (30%) considered and INR of 3 as safe, 36 (10%) considered 3.5 as safe and 36 (10%) considered an INR of 4 as safe. Finally, 286 respondents (86%) considered drug interactions and 236 (71%) considered alcohol as significant influencing factors on INR.
The findings demonstrate a broad change in practice towards the new recommendations produced in 2001 but also highlight that further education and support may be necessary, as well as greater consistency in published guidelines.
确定威尔士西南部的普通牙科医生（GDPs）对华法林治疗患者的当前管理方案，并将这些结果与当前指南以及2003年发表的先前审计结果进行比较。
向威尔士西南部的447名普通牙科医生发送了一份与首次审计中使用的问卷类似的问卷。此外，还包括了关于可能影响国际标准化比值（INR）的因素、术前INR评估的时间以及与种植手术相关的出血风险的问题。普通牙科医生的详细信息来自注册牙科从业者的在线GDC数据库。排除了注册专家和仅从事正畸工作的普通牙科医生。
在分发的447份问卷中，332份（74%）被退回。8%（n = 26）的受访者不治疗服用华法林的患者。247名受访者（74%）认为种植体植入是一种出血风险高的手术，而下颌牙阻滞麻醉、龈下修复和龈下刮治的出血风险较低（分别为45%、28%和12%）。在计划进行高风险手术时，206名受访者（63%）表示他们会向心脏病专家或全科医生寻求建议；没有受访者会建议患者减少华法林剂量，而1%的受访者表示他们会要求患者在未征求任何医学意见的情况下停止服用华法林。共有278名受访者（84%）表示他们会在治疗前检查INR，其中214名（65%）表示会在治疗前24小时内检查，60名（18%）会在48小时内检查。10名受访者表示他们通常不会检查INR。112名受访者（34%）认为2.5是进行高风险手术的安全INR上限，21名（6%）认为INR在1至2之间是安全上限，99名（30%）认为INR为3是安全的，36名（10%）认为3.5是安全的，36名（10%）认为INR为4是安全的。最后，286名受访者（86%）认为药物相互作用，236名（71%）认为酒精是影响INR的重要因素。
研究结果表明，在实践中对于2001年提出的新建议有了广泛的改变，但也强调可能需要进一步的教育和支持，以及已发表指南中更大的一致性。
