Precautions for Patients Taking Antiplatelet Drugs After Stent Insertion During Dental and Endoscopic Procedures

Management guidelines have been identified for patients who have undergone coronary artery stent insertion due to angina or myocardial infarction and are taking antiplatelet drugs when facing dental treatment, endoscopy, or other surgeries. The key is the balance between taking medication to prevent stent thrombosis and the risk of bleeding.

Antiplatelet Medication After Stent Insertion and Bruising

In a video released by the medical channel After the Rain, Professor Bae Jang-hwan of the Department of Cardiology at Chungbuk National University Hospital and Professor Yoon Young-jin of the Department of Cardiology at Wonju Severance Christian Hospital explained medication management methods after stent insertion. After stent insertion, aspirin is used as a base to prevent thrombosis, and depending on the patient's condition, potent dual antiplatelet therapy such as clopidogrel, ticagrelor, or prasugrel is used.

In this process, approximately 10–15% or more of patients may experience bruising. Professor Yoon Young-jin explained that because more potent antiplatelet drugs are often used for recent myocardial infarction patients, the risk of bleeding may increase, and bruising can appear as one of the manifestations. However, she added that such bruising itself does not signify serious bleeding, but caution is required in cases of a history of gastric ulcers or the very rare possibility of cerebral hemorrhage.

Precautions for Discontinuing Medication During Dental and Endoscopic Procedures

The most important thing for stent procedure patients to be careful of when receiving dental treatment or endoscopy is not to arbitrarily discontinue antiplatelet drugs. Professor Bae Jang-hwan advised that since the period for using dual antiplatelet therapy is at least 3 to 6 months, or even as long as one year after stent insertion, it is safer to postpone scheduled dental procedures or endoscopies if possible. This is because if the medication is recklessly discontinued during this period, stent thrombosis—where the barely opened blood vessel becomes blocked again—can occur, leading to fatal situations such as myocardial infarction.

On the other hand, if a certain period has passed since the procedure and the patient has switched to aspirin monotherapy, there are often no major problems in proceeding with dental treatments such as tooth extraction or implants. In the case of endoscopy, if it is for simple screening purposes, it is safe to postpone it for about one year, but if a biopsy is accompanied, the decision must be made in consultation with the primary physician regarding the risk of bleeding and the risk of vessel blockage. In particular, invasive treatments such as submucosal resection for the treatment of gastric cancer, etc., require close cooperation between gastroenterologists and cardiologists.

Medication Management During Joint and Other Surgeries

Even when facing non-emergency surgeries such as knee or hip joint surgery or cataract surgery, it is recommended to postpone the surgery if possible if it is immediately after a stent procedure. Professor Yoon Young-jin explained that if the patient is only taking aspirin, most joint surgeries can be performed, and even in the case of intra-abdominal surgeries such as the stomach or colon, there are many cases where surgery is performed while taking aspirin. However, in cases where the risk of bleeding is high, such as spinal anesthesia or spinal-related surgery, the decision regarding medication intake must be made more carefully.

In conclusion, medical staff emphasized that it is very dangerous for patients who have undergone stent procedures to arbitrarily discontinue medication, and before all procedures and surgeries, they must consult with the primary physician who inserted the stent to decide whether to discontinue the medication.