[Cardiological (pharmaco)therapy and dental practice].
In recent years much progress has been made in the treatment of acute coronary syndromes, heart failure and cardiac rhythm disturbances. Polypharmacy including two antiplatelet drugs (aspirin and clopidogrel) is common in many patients after a percutaneous coronary intervention using a 'stent'. Discontinuation of these drugs for invasive dental treatment may result in coronary rethrombosis. However, in many patients with coronary artery disease, a temporal pause in the use of aspirin appears safe and may decrease the risk of bleeding after a dental procedure. An increasing number of patients with heart failure and/or life threatening rhythm disturbances receive an implantable cardioverter defibrillator (ICD). Such a device, equipped with a left ventricular lead, also stimulates the left ventricle in case of delayed electrical conduction (e.g. a left bundle branch block). This so called cardiac resynchronization therapy decreases morbidity and mortality in selected patients. ICDs are safe in the dental office even in case of discharge. In patients with prosthetic heart valves, endocarditis prophylaxis according to the current guidelines is recommended before invasive dental treatment. Dentists are advised to contact the Dutch Thrombosis Service to discuss the dose of oral ancicoagulants and the required INR value. In case of urgent and/or extended dental procedures, admittence to a hospital must be considered to secure optimal therapy.
Brügemann
J
J
Cardiologie, Universitair Medisch Centrum Groningen. j.brugemann@thorax.umcg.nl
van Gelder
I C
IC
van der Meer
J
J
Zijlstra
F
F
D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000209:etiology* / Q000517:prevention & control; D017147:Defibrillators, Implantable; D006350:Heart Valve Prosthesis; D006801:Humans; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D055502:Secondary Prevention; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin