Antiplatelet drugs: a review of pharmacology and the perioperative management of patients in oral and maxillofacial surgery

Abstract

Introduction An increasing number of patients are taking oral antiplatelet agents. As a result, there is an important patient safety concern in relation to the potential risk of bleeding complications following major oral and maxillofacial surgery. Surgeons are increasingly likely to be faced with a dilemma of either continuing antiplatelet therapy and risking serious haemorrhage or withholding therapy and risking fatal thromboembolic complications. While there are national recommendations for patients taking oral antiplatelet drugs undergoing invasive minor oral surgery, there are still no evidence-based guidelines for the management of these patients undergoing major oral and maxillofacial surgery. Methods MEDLINE and EMBASE databases were searched to retrieve all relevant articles published to 31 December 2017. Findings A brief outline of the commonly used antiplatelet agents including their pharmacology and therapeutic indications is discussed, together with the haemorrhagic and thromboembolic risks of continuing or altering the antiplatelet regimen in the perioperative period. Finally, a protocol for the management of oral and maxillofacial patients on antiplatelet agents is presented. Conclusions Most current evidence to guide decision making is based upon non-randomised observational studies, which attempts to provide the safest possible management of patients on antiplatelet therapy. Large randomised clinical trials are lacking.

Flavonoids: Antiplatelet Effect as Inhibitors of COX-1

“…The role of antiplatelet drugs is to prevent platelet activation either by inhibiting the platelet activation pathways or by stimulating inhibitory pathways [ 6 ]. These include cyclooxygenase (COX) blockers, as well as adenosine diphosphate (ADP) receptor antagonists and glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonists [ 7 ].…”

Avaliação da necessidade de suspensão dos novos anticoagulantes orais para a realização de exodontias: revisão sistemática

“…A literatura, apesar de basear a maioria das evidências atuais para orientar a tomada de decisão em estudos observacionais não randomizados, ainda necessita de fundamentação em uma evidência mais forte para o gerenciamento mais seguro possível de pacientes em terapia anticoagulante (Mahmood, 2020). Para resolução de quadros hemorrágicos em pacientes usuários de NOACs, alguns protocolos defendem o uso de terapias antifibrinolíticas, já que não há nenhuma evidência de dano potencial em relação ao uso de ácido tranexâmico, por exemplo, quando aplicado localmente na prevenção sangramento em pessoas em uso de anticoagulantes orais submetidos a extrações dentárias (Engelen, 2018).…”

Knowledge and Practice of Dentists Managing Patients on Antithrombotic Medications: A Cross-Sectional Survey

“…The literature and practice show that simple local measures in collage sponge or oxidized cellulose packing with hemostatic stitches effectively control postoperative bleeding in patients with antithrombotic or even anticoagulant medications. [18][19][20][21][22] Additionally, several investigators have found that tranexamic acid-soaked gauze, or used as a mouthwash, is quite effective. 13,17 Postoperative pain control is an essential issue in dental practice, especially in patients with concurrent medications.…”