Risk of myocardial infarction persisting after discontinuation of non-steroidal anti-inflammatory drugs in the general population

Management of Antithrombotic Agents in Oral Surgery Maria Martinez and Dimitrios A. Tsakiris

Systemic anticoagulation with intravenous or oral anticoagulants and antiplatelet agents is an efficient treatment against thromboembolic or cardiovascular disease. Invasive dental procedures or oral surgery might be associated with bleeding complications if carried out under anticoagulants. Patients on vitamin K antagonists, new direct anticoagulants or antiplatelet agents having dental interventions with low-risk for bleeding do not need interruption of anticoagulation. In case of bleeding complications local hemostatic measures, such as local surgical sutures, fibrin glue, local antifibrinolytic treatment with tranexamic acid, or e-aminocaproic acid suffice to stop bleeding. In patients with high risk of bleeding an individual assessment of the benefit/risk ratio of interrupting anticoagulation should be carried out. Bridging the long-term anticoagulation with short-term anticoagulants should be planned according to national or international guidelines. The introduction of the newer direct oral anticoagulants having more flexible pharmacokinetic properties has facilitated bridging, allowing short-term interruption without increasing the risk of relapsing thrombotic or cardiovascular events.

Kounis syndrome triggered by diclofenac sodium injection which leads to myocardial infarction and cardiac arrest

Allergic reactions due to drugs may lead to different clinical conditions. Acute coronary syndromes triggered by Type 1 hypersensitivity reactions due to drug intake are known as "Kounis syndrome." Vasospasm occurring in normal coronary arteries (Type 1) and plaque rupture (Type 2) are two variants of this syndrome; both caused by vasoactive and inflammatory mediators due to hypersensitivity reaction. In this case report, we will present Type 2 Kounis syndrome leading to acute anterior myocardial infarction and cardiac arrest in a healthy male after diclofenac sodium injection via intramuscular route. <Learning objective: Incidence of Kounis syndrome due to diclofenac is higher than reported. Some of the myocardial infarction events referred to in the studies might be due to Kounis syndrome. The risk of myocardial infarction probability due to allergic reactions after intake of these drugs must be kept in mind when prescribing.>.