Antiplatelet drug application in dental clinical practice. Efficacy, safety and guidelines: a systematic review.

Background: Antiplatelet (APL) therapy (TH) plays a crucial role in preventing thrombotic (TRB) events in patients with cardiovascular diseases. However, its application in dental clinical practice remains a topic of debate due to concerns regarding bleeding (BL) complications during invasive procedures (PRC). Objective: This systematic review aims to evaluate the efficacy and safety of APL drugs in dental PRCs, assess the risk of BL complications, and examine existing guidelines for managing patients on APL TH. Methods: A comprehensive search was conducted in PubMed, Scopus, and Web of Science for studies published from January 1, 2004 to January 2024. Eligible studies included randomized controlled trials, observational studies, and guidelines evaluating the use of APL drugs in dental PRCs. Data on efficacy outcomes (e.g., prevention of TRB events), safety outcomes (e.g., BL complications), and adherence to guidelines were extracted and synthesized. Results: A total of 28 studies were included in the review, comprising randomized controlled trials, observational studies, and clinical guidelines. The findings suggest that discontinuation of APL TH before dental PRCs may increase the risk of TRB events without significantly reducing BL complications. However, the evidence regarding the risk of BL associated with dental PRCs in patients on APL TH is inconclusive. Existing guidelines vary in their recommendations for managing patients on APL TH, highlighting the need for standardized protocols. Conclusion: APL TH is essential for preventing TRB events in high-risk patients, and its discontinuation before dental PRCs may not be warranted in most cases. However, further research is needed to clarify the risk of BL complications associated with dental PRCs in patients on APL TH and to develop evidence-based guidelines for managing these patients in dental clinical practice. Standardized protocols considering both efficacy and safety outcomes are crucial for ensuring optimal patient care.