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Perioperative Management of Dental Patients on Antiplatelet Medications

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Hemostasis in Dentistry

Abstract

When dental patients on continuous antiplatelet medications present for dental surgery, a decision must be made to continue antiplatelet therapy with potential increased bleeding risks or to interrupt therapy with potential increased embolic risks. But dental surgery is unlike other types of surgery in that major vessels are unlikely to be encountered and most bleeding complications are easy to access without additional surgeries both perioperatively and postoperatively. Of more than 3522 dental patients undergoing more than 6265 dental surgical procedures without interrupting antiplatelet therapy reported in the medical and dental literature, no more than 86 patients (a 2.4% minor bleeding incidence) required additional local measures for hemostasis, and still only two patients (in separate reports) suffered bleeding complications requiring more than local measures for hemostasis, a remarkably low incidence of serious bleeding complications of 0.06%. A close look at these two cases, one over 30 years old and the other over 50 years old, shows that they do not support interrupting antiplatelet therapy for dental surgery. Of 702 patients undergoing at least 752 interruptions of antiplatelet therapy for dental procedures, there were at least 19 embolic complications (2.5% of cessations). These embolic complications included myocardial infarction, stent thrombosis, coronary artery syndrome, and cerebrovascular strokes. Since the review of the literature of antiplatelet interruption for dental procedures includes some case reports and some studies that were not prospective, randomized, and controlled, it is virtually certain that the actual incidence of embolic complications with antiplatelet interruption for dental procedures is significantly lower than 2.5%, but there certainly is an increased embolic risk, regardless of the reason for the interruption. As a result, antiplatelet therapy should not be interrupted for dental surgery.

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  1. Christiana Care Health System, Wilmington, DE, USA

    Michael J. Wahl

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  1. Department of Dentistry, St. Joseph’s Regional Medical Center, Department of Dentistry, Paterson, New Jersey, USA

    Richard P. Szumita

  2. Department of Pharmacy Services, Brigham and Women’s Hospital, Department of Pharmacy Services, Boston, Massachusetts, USA

    Paul M. Szumita

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Wahl, M.J. (2018). Perioperative Management of Dental Patients on Antiplatelet Medications. In: Szumita, R., Szumita, P. (eds) Hemostasis in Dentistry. Springer, Cham. https://doi.org/10.1007/978-3-319-71240-6_12

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