Tuesday, February 20, 2007

Strong Advisory Warning Against the Discontinuation of Dual Aspirin/Clopidogrel (Plavix®) Antiplatelet Therapy in Patients with Coronary Artery Stents

The recommendations from the AHA advisory panel (Circulation, 2007; 115: available at www.circulationaha.org) can be summarized for the dental professional according to the following:
  1. Dental professionals and other healthcare providers who perform invasive or surgical procedures, and are concerned about periprocedural and postoperative bleeding, must be made aware of the potential catastrophic risks of premature discontinuation of antiplatelet (thienopyridine) therapy. The dental professional should contact the patient's cardiologist if issues regarding the patient's antiplatelet therapy are unclear, in order to discuss optimal patient management strategy.

  2. Elective procedures for which there is significant risk of perioperative or postoperative bleeding should be deferred until patients have completed an appropriate course of thienopyridine therapy. The course of this therapy is suggested as 12 months after drug-eluting stent implantation if they are not at high risk of bleeding.

  3. For patients with drug-eluting stents who are to undergo procedures that require discontinuation of thienopyridine (Plavix® or Ticlid®) therapy, aspirin should be continued if at all possible and the Plavix® or Ticlid® restarted as soon as possible after the procedure because of concerns about late-stent thrombosis.

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