Scottish Dental Clinical Effectiveness Programme

Wider context from the report

“The NHS Education for Scotland Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs states that for patients on Clopidogrel dental treatment can occur without interrupting medication. This is in contrast to, for example, patients on Warfarin, who are required to have an INR test prior to any procedure. Mr Hand's tooth extraction was performed as per the current guidance. As he was on Clopidogrel the procedure was carried out with no further checks being carried out as to his clotting function. Following the tooth extraction the site continued to bleed, to the extent that Mr Hand lost consciousness, required hospital admission and subsequently developed aspiration pneumonia. My concern is that as the current guidance does not require any further checks for patients on Clopidogrel prior to dental procedures there is a risk of other patients on Clopidogrel experiencing excess bleeding following dental procedures. It would be of assistance to know whether: a. Has any thought been given to requiring an INR test or any other form of blood test to detect a risk of excess bleeding for patients on Clopidogrel prior to dental procedures? b. If it has not, is there a reason for this? ”