Perceptions of general dental practitioners in Northern Ireland on the clinical management of patients taking direct oral anticoagulants

Statement of the problem:
Despite guidance advocating the management of patients taking Direct Oral Anticoagulants in primary dental care settings, evidence from clinical audit in Northern Ireland suggested that a high proportion of patients were being referred to secondary and tertiary care settings for dental procedures with a bleeding risk.
Purpose of the study
The aim of this study was to evaluate the perceptions of General Dental Practitioners working in the Health Service in Northern Ireland on the clinical management of patients taking DOACs in primary dental care.
Materials and Methods
A questionnaire was distributed to the 1167 registered GDPs in Northern Ireland, assessing perceptions of the clinical management of DOAC patients in primary dental care. The data obtained was analysed using SPSS® statistical software. Qualitative data underwent thematic analysis.
Results
344 questionnaires were analysed. 83% (285) of responding GDPs were aware of the SDCEP guidelines. 98% (337) believed DOAC patients could potentially be managed in primary care but that additional training was required. 80% (275) of GDPs had referred DOAC patients to secondary care. Procedures presenting a low risk of postoperative bleeding complications accounted for 12% (41) of referrals.
Conclusions
A lack of GDP confidence and experience in the management of DOAC patients are motivating factors in referral to secondary care settings for treatment. 12% of the referrals analysed were potentially inappropriate, given the low risk of associated postoperative bleeding complications. Additional training and support for GDPs, as well as enhanced awareness of the SDCEP guidance is essential.