Acute coronary Syndromes - relevance to dentistry Flashcards
What is the relevance of pts with ACS and dental/oral disease?
- antiplatelet therapy - bleeding implications
- antiplatelet therapy - when to stop before procedures
- pts requiring major surgery - perioperative risk
- opportunity to identify pts with high risk symptoms early
What drug are almost all ACS pts on?
Aspirin
What is the standard length of treatment for DAPT?
1 year
What is perioperative risk?
considers surgical complexity, the urgency of the surgery or procedure and individual patient comorbidities
When may DAPT treatment be shorter than 12 months?
pts at high risk of bleeding
anaemic
bleeding in their bowels
duration will be on a discharge letter from cardiologist
What does early termination of antiplatelet drugs cause?
risk of stent thrombosis and MI
When is the highest risk to come off of antiplatelet drugs?
first 6 weeks
minimum 3 months if cant be avoided
If a dental procedure is needed, when is it recommended to do this with regards to ACS?
when course of treatment is completed
if it is necessary to stop the antiplatelet drug earlier - discuss with cardiologist
Pts who are >12 months post ACS with no chest pain/shortness of breath etc - are they stable or unstable?
stable
usually on one drug - aspirin
Can you carry out a dental examination if pt has had ACS?
Yes, a normal non-invasive examination
If a dental procedure requires LA - what is the protocol for ACS pts?
they are low risk but if required within 3 months of ACS or if interruption of antiplatelets are required - discuss with cardiologist
6 months post MI is recommended, still look at drugs the pt is on
Is an LA procedure high or low risk with regards to ACS?
low
Is a head and neck surgery a low, intermediate or high risk with regards to ACS?
intermediate
if a cancer for example - discuss with cardiologist
this is all on a pt-pt basis
