L’uso della doppia terapia aspirina + clopidogrel : rischi in ambito odontoiatrico

Objectives. An increasing number of patients seen in dental practices have altered hemostasis as a result of antithrombotic drug therapy. For the dentists treating such a patient, it is important to know why the patient is using these drugs, the precise effects of the therapy on hemostasis and therefore the hemorrhagic risk, the risks associated with surgical intervention, and how to manage perioperative and postoperative bleeding. In recent years, there has also been an increase in the number of patients on dual antiplatelet therapy, in particular that based on aspirin and clopidogrel. The aim of this article is to review the latest indications on the correct management of patients on dual antiplatelet therapy and to provide guidelines based on the international scientific literature, which can be used by readers in daily clinical practice. Materials and methods. We conducted a thorough review and analysis of recent scientific literature in the fields of dentistry and cardiology. Results. There is a lack of methodologically valid studies (randomized clinical trials) on this problem. The review revealed diverse opinions on the actual risks associated with suspension of clopidogrel in patients on a dual therapy regimen. Conclusions. Dentists should know the therapeutic indications for these new drugs and the risks linked to their suspension, and this is even more important than with anticoagulant therapy or with antiplatelet therapy based on aspirin alone. During periods of high risk for thrombosis, any unnecessary oral surgery should be postponed to avoid interrupting the dual therapy.