Advances in Antiplatelet Therapy for Dentofacial Surgery Patients: Focus on Past and Present Strategies

Abstract

Background: Nowadays, patients involved in antiplatelet therapy required special attention during oral surgery procedures, due to the antiplatelet drugs assumption. The motivations of the assumption may be different and related to the patient’s different systemic condition. For this reason, accordingly to the current international guidelines, different protocols can be followed. The aim of this work is to analyze how the dentist’s approach to these patients has changed from the past to the present, evaluating the risk exposure for the patients. Methods: This review paper considered different published papers in literature through quoted scientific channels, going in search of “ancient” works in such a way as to highlight the differences in the protocols undertaken. The analyzed manuscripts are in the English language, taking into consideration reviews, case reports, and case series in such a way as to extrapolate a sufficient amount of data and for evaluating the past therapeutic approaches compared to those of today. Results: Colleagues in the past preferred to subject patients to substitution therapy with low molecular weight anticoagulants, by suspending antiplatelet agents to treatment patients, often for an arbitrary number of days. The new guidelines clarify everything, without highlighting an increased risk of bleeding during simple oral surgery in patients undergoing antiplatelet therapy. Conclusion: Either patients take these medications for different reasons, because of cardiovascular pathologies, recent cardiovascular events, or even for simple prevention, although the latest research shows that there is no decrease of cardiovascular accidents in patients who carry out preventive therapy. Surely, it will be at the expense of the doctor to assess the patient’s situation and risk according to the guidelines. For simple oral surgery, it is not necessary to stop therapy with antiplatelet agents because the risk of bleeding has not increased, and is localized to a post-extraction alveolus or to an implant preparation, compared to patients who do not carry out this therapy. From an analysis of the results it emerges that the substitutive therapy should no longer be performed and that it is possible to perform oral surgery safely in patients who take antiplatelet drugs, after a thorough medical history. Furthermore, by suspending therapy, we expose our patients to more serious risks, concerning their main pathology, where present.

Oral Health and Molecular Aspects of Malignant Fibrous Histiocytoma Patients: A Systematic Review of the Literature

“…Only one study reported a relapse of the disease 2 weeks after a first surgery consisting of local excision with maxillectomy [38], while 4 studies made no reference to recurrence [32][33][34]40]. These invasive surgeries often require post-surgical rehabilitations [51,52], and in some cases are made complex by the presence of local contraindications (noble anatomical structures [53][54][55][56], or systemic contraindications (general health conditions of the patient [22][23][24]26,57]). Post-surgical and infection management are important [27,28,30].…”

“…Distant metastases of MFH commonly occur via hematogenous or lymphatic spread [1,6,20,21]. Unfortunately, it is not always possible to intervene in a timely manner in these cases, due to delays related to diagnosis or systemic conditions of the patient who need adequate protocols or therapies [22][23][24]. Many syndromic patients or those suffering from systemic diseases may also present intra and post-operative complications [23,25,26] or represent a high post-surgical infection risk [27][28][29] and therefore need adequate therapies [27,30].…”

"The inflammation link between periodontal disease and coronary atherosclerosis in patients with acute coronary syndromes - case-control study".

“…It should be remembered, however, that during the dental examination, patients in accordance with acute coronary syndromes treatment standards were already on dual antiplatelet therapy, which undoubtedly increases the risk of bleeding [20,44]. Moreover, the severity of bleeding may be a clear evidence of the effectiveness of antiplatelet therapy, while it might be a problem in dental treatment in the period after acute coronary syndromes [45]. The explanation for this apparently unexpected relationship can therefore be seen in that -it is a net effect of the severity of periodontitis and the increased bleeding tendency associated with dual antiplatelet therapy.…”

We Do Not Eat Alone: Formation and Maturation of the Oral Microbiota

“…The similarities between peri-implant microbial and subgingival deposits have been clearly demonstrated by cross-sectional and longitudinal studies, and it is possible to state that the structure of peri-implant plaque deposits may resemble those encountered in the subgingival environment. The presence of a complex biofilm could have repercussions at the systemic level, or even have repercussions on surgical operations performed in the oral cavity [31][32][33][34][35][36][37][38][39].…”