Key Points
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Presents an overview on the use and pharmacology of aspirin and clopidogrel.
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Highlights the difficulties in managing patients on dual antiplatelet therapy.
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Reviews the current literature on dual antiplatelet therapy during oral surgical treatments.
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Outlines a protocol for the management of patients on dual antiplatelet therapy.
Abstract
Background Haemostasis is crucial for the success of oral surgical treatment as bleeding problems can cause complications both pre- and post-operatively. Patients on antiplatelet drugs present a challenge due to their increased risk of bleeding.
Aims To identify a protocol for the management of oral surgery patients on dual antiplatelet therapy (aspirin and clopidogrel).
Methods A literature review was conducted in January 2016 of free-text and MESH searches (keywords: aspirin, clopidogrel and dental extractions) in the Cochrane Library, PubMed and CINAHL. Trial registers, professional bodies for guidelines and OpenGrey for unpublished literature were also searched. Studies were selected for appraisal after limits were applied (adult, human and English only studies) and inclusion/exclusion criteria imposed.
Results Eight studies were identified for critical appraisal using the CASP tools. These were a combination of retrospective, prospective, cohort and case control studies. Napenas et al. and Park et al. found no statistically significant risk of postoperative bleeding complications in patients on dual antiplatelet therapy. Girotra et al., Lillis et al., Omar et al. and Olmos-Carrasco et al., however, found statistically significant risk of postoperative bleeding in this group of patients, all of which can be controlled with local measures.
Conclusion Patients on dual antiplatelet therapy – although at an increased risk of postoperative bleeding complications - can be managed safely with local haemostatic measures and without the need to discontinue antiplatelet therapy.
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Nathwani, S., Martin, K. Exodontia in dual antiplatelet therapy: the evidence. Br Dent J 220, 235–238 (2016). https://doi.org/10.1038/sj.bdj.2016.173
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DOI: https://doi.org/10.1038/sj.bdj.2016.173
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