Cardiovascular

Dental Management of Patients with Coronary stent (on DAPT)

Confirm date of coronary stent

Timing since stent placement and DAPT status determine risk of interrupting antiplatelets.

Emergency vs routine management

If EMERGENCY — what to do

• Do NOT stop dual antiplatelet therapy — treat with local haemostasis.Ref: Levine GN et al. 2016 ACC/AHA Focused Update on Duration of Dual Antiplatelet Therapy. Circulation 2016;134:e123–e155
• Use local haemostatic measures: oxidised cellulose/collagen packing, sutures, pressure and tranexamic acid 5% mouthwash.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
• Within 6–12 months of stenting, liaise with the cardiologist before extensive surgery.Ref: Levine GN et al. 2016 ACC/AHA Focused Update on Duration of Dual Antiplatelet Therapy. Circulation 2016;134:e123–e155

If ROUTINE — what to do

• Defer elective surgery until DAPT is complete (≈ 6 months after elective stent; 12 months after ACS).Ref: Levine GN et al. 2016 ACC/AHA Focused Update on Duration of Dual Antiplatelet Therapy. Circulation 2016;134:e123–e155
• Non-surgical routine care can proceed.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
• Limit adrenaline to 0.04 mg (≈ 2 cartridges of 1:80,000–1:100,000), aspirate and inject slowly.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023

Clinical precautions

• Do NOT stop dual antiplatelet therapy without cardiology advice
• Use local haemostatic measures (pressure, sutures, oxidised cellulose)

Information & tests to request

• Days since coronary stent placement

At a glance by procedure

Initial assessment before lab results or timing details are entered.

Procedure	Initial assessment
Examination / radiographs	MODIFY / CAUTION Confirm date of coronary stent
Supragingival scaling / polish	MODIFY / CAUTION Confirm date of coronary stent
Deep scaling / subgingival RSD (subgingival calculus)	MODIFY / CAUTION Confirm date of coronary stent
Root canal treatment	MODIFY / CAUTION Confirm date of coronary stent
Simple extraction (1–3 teeth)	MODIFY / CAUTION Confirm date of coronary stent
Surgical / bony extraction	MODIFY / CAUTION Confirm date of coronary stent
Implant placement	MODIFY / CAUTION Confirm date of coronary stent

Get a patient-specific decision in seconds

Combine all conditions, medications, lab results and the planned procedure — with anaesthetic dose calculation, lab requests and a referral letter PDF.

References

SDCEP 2022 — Anticoagulants & Antiplatelets
AHA — DAPT management
Levine GN et al. 2016 ACC/AHA Focused Update on Duration of Dual Antiplatelet Therapy. Circulation 2016;134:e123–e155
SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023

This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.