Dental management of patients using anti agregant drugs: background, risks and clinical guidelines

The object of this review is to juxtapose the risk of discontinuing anti-thrombotic therapy versus the benefit of less bleeding during dental procedures. The use of anti-thrombotic therapy to prevent cardiovascular thrombotic events is fundamental in the treatment of arterial sclerosis. Aspirin and Clopidogrel (Plavix) are the two anti-thrombotic drugs mainly used for this purpose. In patients with a history of symptomatic arteriosclerotic heart disease, aspirin therapy reduces the risk of myocardial infarction. Since the risk of recurrent cardiovascular event is known to be higher during the first few months following a symptomatic cardiovascular event, optimal treatment during this period is crucial. Any patient suffering from symptomatic arteriosclerosis should receive permanent anti-thrombotic therapy, unless strongly contraindicated. Poor compliance with or discontinuation of the anti-thrombotic therapy is associated with higher risk for a cardiovascular events. The risk of a cardiovascular event increase 3-4 days after discontinuation of anti-thrombotic therapy. A conventional dental treatment does not normally cause massive bleeding in patients using antithrombotic therapy. There is no evidence to support discontinuation of antithrombotic therapy prior to dental procedures. Therefore, considering the importance of anti-thrombolitic therapy in ateriosclerotic patients and the risk involved in discontinuing this therapy on the one hand, and the low risk of significant bleeding during dental procedures in patients using anti-thrombotic therapy on the other hand, one should be extra cautious in discontinuing antithrombotic therapy before dental procedures. Our recommendations are detailed in the article.