There is a host of contraindications to using thrombolytic therapy to treat acute ischemic stroke (AIS), one of which is recent surgery.
It is likely that the quantity of patients presenting with AIS following oral surgery will rise given the increasing use of implants and more frequent discontinuation of anti-coagulants prior to dental procedures.
While there is not much data on the risk of bleeding after use of thrombolytics in patients who have recently undergone minor dental surgery, some case reports have shown there to be an association with substantial hemorrhage.
TAKE HOME POINT: Remember to consider minor surgical procedures, such as dental, as a contraindication when screening acute stroke patients who are potential candidates for thrombolytic therapy; often, patients and their family members may not consider such procedures to be "surgery."
References
Jimenez M, et al. Periodontitis and incidence of cerebrovascular disease in men. Annals of Neurology. 2009;66:505-512.
Seifert CL, et al. Systemic thrombolysis in ischemic stroke after recent oral surgery and management of oral cavity bleeding. Annals of Emergency Medicine. Vol 57, No. 5.. May 2011.
