Incidence of bleeding during and after two non-surgical periodontal therapy schemes in patients with recent acute coronary syndrome on dual antiplatelet therapy: A pilot study.

Abstract

Background: This study aimed to compare the incidence of bleeding using two periodontal treatment protocols in patients with recent Acute Coronary Syndrome (ACS).

Material and methods: This is an interim analysis of a double-blind controlled clinical trial evaluating two periodontal treatment schemes in patients with recent ACS treated with different dual antiplatelet regimens: Clopidogrel+ASA, Prasugrel+ASA and Ticagrelor+ASA. After randomisation six patients (22 quadrants) were treated with Scheme A (scaling and root planning-SRP) and six patients (21 quadrants) with Scheme B (ultrasonic scaling-US). Periodontal therapy was performed in two appointments using a preventive local protocol to avoid bleeding. The incidence of bleeding was evaluated at 30 minutes and 12 and 24 h later. The clot formation time and perioperative bleeding were also assessed and associated with the regimen using Chi-square/Fisher tests.

Results: Profuse bleeding during treatment was significantly higher in patients with SRP 9/22 (40.91%) than in those with US 2/21 (9.52%) (p = 0.018). Intra-operatory bleeding in quadrants was major in SRP treated with Clopidogrel +ASA (p = 0.009). Only 2/12 patients presented with late bleeding after periodontal treatments, representing 16.6% per individual and 11.6% (5/43) per quadrant. However, the incidence of bleeding did not differ significantly between the two protocols.

Conclusions: Post-treatment bleeding was moderate and similar in non-invasive and invasive periodontal treatment with different dual antiplatelet therapies. The periodontal treatment in patients with recent ACS treated with dual antiplatelet therapy is safe. The incidence of bleeding is low, and it can be controlled using local methods. Key words:Bleeding, dual platelet anti-aggregation, periodontitis, acute coronary syndrome.