Moderate surgery with Patient on Brilinta?

If you have done procedures on patients with plavix before, you should be fine with Brilinta. This is the conclusion from a meta-analysis comparing both. " Our present findings suggest similar efficacy and safety profiles for clopidogrel and ticagrelor Ticagrelor should be considered as a valuable option to reduce the risk of bleeding, MI and stroke, whereas potentially increases the incidence of dyspnea. Given the metabolic process, ticagrelor may be a valid and even more potent antiplatelet drug than clopidogrel, as an alternative strategy in treating patients with clopidogrel intolerance or resistance." Take the same precautions for plavix. I usually keep patients like these with moderate to major oral/perio surgery for about 30-60 minutes under observation in my office. Good luck

In my experience Ticagrelor is not a good drug to play with when it comes to surgery. Even in a simple scaling/root planing. I would remove Aspirin 7 days prior and remove Ticagrelor 5 days prior. One day before Ticagrelor cessation (6 days prior to surgery) have the patient administer him/herself subcutaneous Lovenox injections (Enoxaparin) usually 40mg is more then enough once a day. 24 hours after the surgery if no bleeding occurs start Aspirin and Ticagrelor and have the patient administer his/herself the last dose of Enoxaparin. If the patient did not use Enoxaparin before have a nurse explain to the patient how to auto-administer the injections or have a nurse to administer the drug to the patient. If you don't feel comfortable with this prescriptions (I have no idea how these prescriptions work in your home country) then let the patient visit his physician or cardiologist. Of course I've heard a lot of colleagues telling me that they don't even care about those type of drugs even when performing All-on-4 or sinus lift surgery. The bleeding is controlled in situ. But well... we don't all think the same way.

Here in the U.S., we typically do not alter these regimens on the newer generation antiplatelets. The risk of adverse events (embolus) typically outweighs any bleeding from oral surgery. However, always a good idea to consult with Physician.

If you are contemplating an all on 4-6 and extractions then you want to consider doing this in a hospital environment on this patient. The ridge reduction necessary to allow for the height of the prosthetic will open up multiple marrow spaces. As well there is no reversal agent for this anticoagulant. (There is a very expensive one but you do not want to to have to use it) . I agree with the prior comment regarding Lovenox. Have a phone conversation with the cardiologist, explain just how involved the surgery is that you are planning, often they think your just doing a simple extraction.

I agree with all the above comments...…….as important and as necessary is the dental treatment, this is a situation where the dentist must be guided by the medical professionals every step of the way. Situations such as this case will increasingly become more common with people living much longer than in the past...…...it would be wonderful if the dentist who posted this case, would continue to keep us up to date on the situation, as we can all learn from it, and many of us will be faced with similar situations.....good luck.

I agree with hospital setting. One should be aware that discontinuing anticoagulant therapy for surgery and then restarting said therapy puts the patient at higher risk for a thrombo-embolic event in the weeks following restart of anticoag therapy. Always weigh the risks of the surgery against the benefits of surgery and unfortunately sometimes the words of the Rolling Stones ring true for the patient: "you can't always get what you want!"