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Dental management of patient with dual antiplatelet therapy: a meta-analysis

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Abstract

Background

It is more common to need dual antiplatelet therapy (DAPT) for patients who had recently inserted coronary artery stent. However, the postoperative bleeding risk of patients in DAPT could significantly increase. The dental management of patients with antithrombotic therapy has always been a controversial problem. Focusing on this issue, this review discussed the available evidence to provide optimal strategy for patients taking dual antiplatelet agents in the dental setting.

Methods

We searched the PubMed, Embase, ScienceDirect, Web of Science (WOS), Cochrane Library, and China National Knowledge Infrastructure (CNKI) which was performed in May 2018. Relevant articles were included according to our inclusion and exclusion criteria. Meta-analysis was conducted with fixed effects models. Subgroup analysis was used due to different dental surgeries.

Results

Our meta-analysis included ten studies (continue DAPT vs. placebo, 535 patients vs.2907 patients). The quantitative results indicated that the risk of postoperative bleeding with continuing DAPT experienced significantly increase (RR = 1.95 95% CI [1.07, 3.54]; p = 0.03). There was no statistically significant difference between the postoperative bleeding rate and different dental surgeries (p = 0.72).

Conclusion

On the current studies, postoperative hemorrhage is exacerbated with DAPT, but it could be controlled by enhancing hemostasis methods. We recommend continuing long-term DAPT before tooth extraction.

Clinical relevance

In this work, we systematically evaluated and summarized the results of small clinical trials after reviewing the present literatures on this topic, so that we could propose more objective and more accurate evidence-based recommendations on dental management for patient with dual antiplatelet therapy.

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Authors and Affiliations

  1. Dental Student, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China

    Lin Li, Yun Yang, Liyuan Zhao & Xinyao Zhou

  2. Department of Prosthodontics, Hospital of Stomatology, Tianjin Medical University, Tianjin, China

    Wenyi Zhang

  3. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Tianjin Medical University, Tianjin, China

    Jian Zhang

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  1. Lin Li
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Correspondence to Jian Zhang.

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Li, L., Zhang, W., Yang, Y. et al. Dental management of patient with dual antiplatelet therapy: a meta-analysis. Clin Oral Invest 23, 1615–1623 (2019). https://doi.org/10.1007/s00784-018-2591-y

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