Management of Patients with Cardiovascular Conditions 5th Edition
7
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Once the stent is inserted, the patient is usually
maintained indefinitely on a regiment of aspirin
and/or triclopridine in order to reduce risk for a
platelet-induced thrombus formation.
Stents are
placed either during elective (unstable angina) or
emergent procedures (post myocardial infarction).
Myocardial infarction is the most common reason
for placing a stent in an emergency situation. For
patients with stents, the dentist should consider
the underlying reason for placement of the stent,
the medications used after stent placement and
the need for antibiotic prophylaxis for invasive
dental procedures.
6
If the stent was placed for a
myocardial infarction, elective dental care should
be delayed for approximately six months.
Aspirin
will increase the bleeding time but does not place
the patient at increased risk for uncontrolled
hemorrhage during invasive dental procedures.
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Table 3 - Dental Procedures and Endocarditis Prophylaxis
8,9
Endocarditis prophylaxis recommended:
Antibiotic prophylaxis is recommended for all
dental procedures that involved manipulation of gingival tissue or the periapical region of teeth
or perforation of oral mucosa.
If a patient in the highest risk category is receiving chronic antibiotic treatment with an antibiotic
that is recommended for infective endocarditis prophylaxis, it is recommended to select an
antibiotic from a different class rather than increase the dosage of the current antibiotic.
Endocarditis prophylaxis not recommended:
Antibiotic prophylaxis is not recommended for
routine anesthetic injections through noninfected tissue, taking dental radiographs, placement
of removable prosthetic or orthodontic appliances, adjustment of orthodontic appliances,
placement of orthodontic brackets, shedding of primary teeth and bleeding from trauma to the
lips or oral mucosa.
Prophylaxis in not recommended for patients with coronary bypass graft surgery, coronary
artery stents, and patients with uncomplicated heart replacement surgery.
JAMA, 138:739-760, 2007
Table 4 - Prophylactic Regiments for Dental Procedures
9,13
Standard oral regiment:
Amoxicillin
Adults: 2.0 g; children: 50 mg/kg: orally 30 to 60 minutes before procedure
Unable to take oral medication:
Ampicillin
Adults: 2.0 g intramuscularly (IM) or intravenously (IV); children: 50 mg/kg IM or IV 30 to 60 minutes before procedure
or
Cefazolin or Ceftriaxone
Adults: 1.0 g intramuscularly (IM) or intravenously (IV); children: 50 mg/kg IM or IV 30 to 60 minutes before procedure
Allergic to Penicillins or Ampicillin
Cephalexin
Adults: 2.0 g intramuscularly (IM) or intravenously (IV); children: 50 mg/kg IM or IV 30 to 60 minutes before procedure
or
Clindamycin
Adults: 600 mg; children: 20 mg/kg orally 30 to 60 minutes before procedure
or
Azithromycin or Clarithromycin
Adults: 500 mg; children: 15 mg/kg orally 30 to 60 minutes before procedure
Allergic to Penicillins or Ampicillin and Unable to Take Oral Medications
Cefazolin or Cefazolin or Ceftriaxone
Adults: 1.0 g intramuscularly (IM) or intravenously (IV); children: 50 mg/kg IM or IV 30 to 60 minutes before procedure
or
Clindamycin
Adults: 600 mg; children: 20 mg/kg IV 1 h prior to procedure
*Total children’s dose should not exceed adult dose
#Cephalosporins should not be used in individuals with immediate-type hypersensitivity reaction (urticaria, angioedema or anaphylaxis) to any form of penicillin,