Safety of Dental Extractions in Coronary Drug‐Eluting Stenting Patients Without Stopping Multiple Antiplatelet Agents

Abstract

Background:The risk of excessive bleeding prompts physicians to stop multiple antiplatelet agents before minor surgery, which puts coronary stenting patients at risk for adverse thrombotic events.Hypothesis:We hypothesized that most dental extractions can be carried out safely without stopping multiple antiplatelet agents.Methods:All dental extraction patients who had undergone coronary stenting and who were also on oral multiple antiplatelet agents therapy were enrolled. One hundred patients underwent dental procedures without stopping antiplatelet agents. All wounds were sutured and followed up at 24 hours, 1 week, and 1 month after the procedure. There were 2233 patients who had not taken oral antiplatelet agents from a health promotion center and had teeth extracted by the same method. After performing propensity‐score matching for the entire population, a total of 100 matched pairs of patients were created. The primary outcome was a composite of excessive intraextraction blood loss, transfusion, and rehospitalization for bleeding, and the secondary outcome was a composite of death, nonfatal myocardial infarction, target lesion revascularization, and stent thrombosis within 1 month after the procedure.Results:There were 2 excessive intraextraction bleeding cases that continued at the extraction site for 4 and 5 hours, respectively, in the coronary stenting patients, and 1 excessive intraextraction bleeding case that continued for 3 hours in the control patients. There were no cases of transfusion, rehospitalization for bleeding, or major cardiovascular events for the 2 propensity‐matched groups.Conclusions:We found that most dental extractions in coronary stenting patients can be carried out safely without stopping multiple antiplatelet agents.The authors have no conflicts of interest to disclose.This study was supported in part by a grant from Yuhan Corporation, Ltd., Seoul, The Republic of Korea.

Gestion péri-opératoire des patients traités par antithrombotiques en chirurgie orale. Argumentaire

“…Une liste non exhautive des principaux actes de chirurgie orale, classé en fonction du risque hémorragique est présentée dans l'annexe 2. Il s'agit des soins dentaires ou parodontaux ainsi que les actes chirurgicaux pour lesquels les pertes sanguines sont faibles (volume < 50 mL, aucun cas de transfusion plaquettaire rapporté) [24,21,239], non critiques par leur localisation et facilement contrôlables par des mesures simples d'hémostase mécanique.…”

“…Aframian, 2007 [1], Ardekian, 2000 [24], Bajkin, 2012 [35], Bajkin, 2015[36], Brennan,2008[49],Canigral,2008 [54]Cardona-Tortajada, 2009 [56], Garnier, 2007 [113], Iwabuchi, 2014 [173], Krishman, 2008 [185], Lillis, 2011 [197], Madan, 2010 [204],] Medeiros, 2011 [212], Moritomoto, 2008a [223], Morimoto, 2011 [225], Napenas, 2009 [227], Olmos-Carrasco, 2015 [234], Park, 2012 [239], Partridge, 2008 [237], Rai, 2013 [248], van Diermen, 2009 [278], Verma, 2013 [280], Verma, 2014 [281] Etape 3 «Antiplatelet» OU " «Aspirin» OU «Dipyridamol» OU «Ticlopidin»OU«Clopidogrel»OU«Prasugrel»OU«Ticagrelor» "ET" « Dental implant »…”

Is the Practice of Discontinuing Aspirin Therapy Prior to Dental Extraction Correct? A Review

“…37 Bajkin B.V. et al conducted a prospective clinical study by performing simple dental extractions on 43 patients taking 2 anti-platelet drugs, mostly aspirin and clopidogrel and 117 patients taking a single antiplatelet drug in the form of aspirin, clopidogrel and ticlopidine. Bleeding was recorded after extraction in only one patient on dual aspirin-clopidogrel treatment, which was mild and easily controlled by local haemostasis.…”

Extração dentária em pacientes com doença arterial coronariana em terapia antiplaquetária dual

“…al., 2002;Owens;Belkin et al, 2005;Pototski e Amenábar;et al, 2007). A interrupção pré-operatória de antiagregantes plaquetários, visando diminuir complicações hemorrágicas, pode desencadear um aumento rebote na ativação e agregação plaquetária, aumentando a probabilidade de um evento tromboembólico no paciente cardiopata (Sharma et al, 2004;Ferrari et al, 2005;Pfisterer et al, 2006;Krishman;Shenoy et al, 2008;Lillis et al, 2011;Park et al, 2012 (Floyd;Ferro, 2014), ou da inibição do receptor P2Y12 da adenosina difosfato (ADP), por meio do clopidogrel. As terapias mais utilizadas no tratamento e prevenção das DAC tem seu foco voltado para os ativadores ADP e TXA2 (Cheng, 2013).…”

“…Isto faz com que muitos profissionais recomendem a suspensão da medicação antes de qualquer procedimento cirúrgico odontológico, entretanto, a suspensão desta terapia expõe os pacientes portadores de stent coronariano à riscos adversos de eventos trombóticos. (Lillis et al, 2011;Park et al, 2012) Com o objetivo de construir diretrizes clínicas práticas para os cirurgiões-dentistas, Van Diermen et al (2009) Lordkipanidzé, 2013; Janssen; ten Berg, 2013). As vantagens e desvantagens de cada exame bioquímico estão descritas no quadro abaixo (quadro 2).…”