Anti-Platelet Drugs and Dentistry

Dr.George Paul MDS, DNB, LLB

Introduction: Over the past four decades, several factors have increased the responsibility of dental professionals in treating patients with cardiac conditions. The paradigm shift in management is influenced by three key factors: 1.Increased life expectancy in the population. New interventions and surgical procedures for cardiac diseases. 2. The use of prophylactic and post-operative anti-platelet drugs impacting dental treatment. 3. Dentists must continuously update their knowledge about the medical conditions of their dental patients. They must be aware about the actions of various drugs. This article examines the icare required for patients on anti-platelet drugs seeking minor dental surgical procedures. Life Expectancy: Life expectancy has significantly increased in most countries over the past four decades. More people are living into their eighties and nineties due to reduced mortality from infections, diarrheal diseases, and vaccine-preventable illnesses. Paradoxically, improved cardiovascular health (CVH) through prevention and interventions has reduced early cardiovascular death (CVD), contributing to healthier aging (1). Consequently, more elderly patients are seeking dental treatment, many of whom are on anti-platelet drugs as prophylactic measures or secondary prevention following cardiac or neurological events. Cardiac Surgery and Interventions: Ischemic heart disease has historically been a debilitating and sometimes a fatal condition. Before the 1950s, treatment was primarily conservative, with rest and pain management being the only available options. The introduction of cardiac care units revolutionized treatment by enabling continuous ECG monitoring, the use of lidocaine, vasodilators , Ionotrops and new drugs drugs for restoring rate and rhythm,Thrombolysis and anti-thrombotic medications (2). Anti –thrombotic medications, however, had the potential to cause bleeding. Specialized ICU nurses increased the level of care. From the late 1960s to the present, various surgical revascularization procedures, such as coronary artery bypass grafting (CABG) and endovascular interventions like PTCA, have significantly improved outcomes for patients with life-limiting atherosclerotic heart disease. Over time, these procedures have become progressively safer and more effective. However, while they provide life-changing relief, they also necessitate lifelong use of anti-platelet medications that impede clotting. Despite low dosages, these drugs had some inherent risks to cause mild spontaneous and post -operative bleeding. This article evaluates the potential impact of these drugs on surgical dentistry. Anti-Platelet Drugs Impacting Dental Treatment: Anti-platelet drugs can be categorized as follows: 1.Conventional Anti-Platelet Drugs 2.Novel Anti-Platelet Drugs Although these drugs fall under the broader category of anti-thrombotic agents, the antiplatelet drugs vary from anti-coagulant drugs. Drugs like Aspirin could be used in low doses with the same therapeutic effects on as anti-thrombotics. Anti -Coagulants act differently and will be addressed separately. Previous studies have demonstrated that, in dental procedures, the risk of thrombotic events from altering or discontinuing antithrombotic therapy far outweighs the low risk of perioperative bleeding complications among patients on single or dual anti-platelet therapy or even vitamin K antagonists (5,6).