Purpose: We examined correspondence of doctors and dentists at the time of surgeries or biopsy in patients treated with antithrombotics by questionnaire survey.
Methods: We investigated management of antithrombotic therapy at dental extraction, biopsy or polypectomy under an endoscope, an operation of a cataract, pacemaker implantation by questionnaire survey for doctors and dentists in 64 national hospital organization hospitals (NHO-hospital) and doctors in 163 hospitals participated in the Japan Multicenter Stroke Investigators' Collaboration (J-MUSIC) study. We compared the results between NHO-hospitals and J-MUSIC hospitals.
Result: The doctor questionary survey got an answer from 103 institutions (63%) out of the 163 J-MUSIC hospitals and 26 institutions (40%) out of 64 NHO-hospitals. The dental extraction under continuation of warfarin therapy in patients with past history of stroke and non-valvular atrial fibrillation or mechanical heart valves was accepted in 35% and 45%, respectively. They were 58% and 69%, respectively in J-MUSIC hospitals and were significantly higher than those in NHO-hospital (p = 0.031 and p = 0.023, respectively). There were no significant differences in antithrombotic management strategies in correspondence to the biopsy, polypectomy or pacemaker implantation between the two groups of hospitals. Continuation of the antithrombotic therapy at surgery to cataracta was more frequent in J-MUSIC hospitals than in NHO-hospitals (nonvalvular atrial fibrillation 48% vs 22% p = 0.015, mechanical heart valve 51% vs 30% p = 0.059). Experience of stroke due to transient withdrawal of warfarin (69% vs 27%, p = 0.0005) and antiplatelet (59% vs 31%, p = 0.022) therapies were more frequently seen in the J-MUSIC hospitals than in the NHO-hospitals. The dentist questionary survey got an answer from 30 institutions (44%) out of the NHO-hospitals. The acceptance rates of dental extraction under continuation of warfarin or antiplatelet therapies were 53% and 60%, respectively.
Conclusion: It is suggested that constant consensus is provided with a medical institution as for the biopsy, polypectomy, and pacemaker implantation without a difference being seen in both medical institution groups. However, acceptance rate under antithrombotic therapy at dental extraction or surgery for cataracta was higher in the J-MUSIC hospitals than in the NHO-hospitals, which may be due to lack of the consensus to antithrombotic therapy for those surgeries and higher rate of doctors' experience of stroke after withdrawal of antithrombotic therapy in J-MUSIC hospitals.