76-year-old man for upper dental clearance
- Significant tooth decay and gum disease
- Affecting ability to eat and impacting on QoL
- AF – on Apixaban
- OSA – CPAP
- Mycotic AAA – EVAR 2019. On lifelong clopidogrel
- NIDDM – HbA1c – 6.6%
- Recent CVA – Feb 2021. Lacunar infarct of internal capsule and Thalamus.
- 3 previous CVA’s
- Dysphagia due to previous CVA.
- Dentition worsening oral intake and exacerbating symptoms
- Patient very keen for procedure to be done as soon as possible
- Elective procedure
- Current evidence recommends elective surgery should occur 9 months post CVA for risk reduction (Perioperative stroke after non-cardiac, non-neurological surgery – BJA Education)
Ongoing ischaemic events on anticoagulation and anti-platelet therapy
- Will the risks be significantly reduced in this patient after 9 months?
- Other options – outpatient dental procedures are done on anticoagulant therapy, can he have some of his teeth out in the community while awaiting full dental clearance?
- Should Neurologist/Haematologist advice should be sought regarding the cause of the CVA’s and management of anticoagulation
- Discussion with surgical team:
- Further review with regards to symptomatic management options.
- Happy to extract teeth with uninterrupted clopidogrel therapy
- Liaise with neurologist and haematologist