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Surgical management of the primary care dental patient on antiplatelet medication

Publisher: North West Medicines Information Centre

Keywords: Antiplatelets; Dentistry-operative; tooth extraction; aspirin; clopidogrel; prasugrel; dipyridamole

Date published: 01/08/2010 00:00

Review date: 31/08/2012 00:00

Summary
by: Christine Randall
  • Oral antiplatelet medicines available in the UK are low-dose aspirin (75mg-300mg daily), clopidogrel (e.g. PlavixÒ), dipyridamole (PersantinÒ, Persantin RetardÒ), aspirin plus dipyridamole (Asasantin RetardÒ) and prasugrel (EfientÒ).
  • The combination of aspirin plus clopidogrel or prasugrel is mainly used in patients with acute coronary syndrome (ACS) and following stent insertion. The combination of aspirin plus dipyridamole is used for the prevention of strokes or TIAs.
  • Patients taking antiplatelet therapy have a prolonged bleeding time but this may not be clinically relevant. Dual antiplatelet therapy with aspirin plus dipyridamole poses a similar bleeding risk as aspirin monotherapy. Dual antiplatelet therapy with aspirin plus clopidogrel or prasugrel increases bleeding time more than either alone.
  • Stopping antiplatelet therapy increases the risk of stroke, myocardial infarction or stent thrombosis; patients are more at risk of permanent disability or death if they stop antiplatelet medication prior to a dental procedure than if they continue it.
  • Due to the high risk of catastrophic thromboembolic events in patients taking dual antiplatelet therapy (aspirin plus clopidogrel, aspirin plus prasugrel) following stent insertion they should not have their antiplatelet medication altered or stopped without consulting the interventional cardiologist.
  • Bleeding complications following dental procedures, while inconvenient, do not carry the same risks as thromboembolic complications.
  • Postoperative bleeding after dental procedures can be controlled using local haemostatic measures in patients taking mono or dual antiplatelet therapy.
About this library entry
Category: 2.9 Antiplatelet drugs | Clinical guidelines | Dentistry
NeLM area:  Evidence > Medicines Q & A
Surg_mngemnt_of_pc_dental_patient_on_antiplatelet_med_Aug10.doc

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