Is a male patient with a history of transient ischemic attack (TIA) and uncontrolled hypertension (HTN), currently taking lisinopril (angiotensin-converting enzyme inhibitor) 5 mg and aspirin (acetylsalicylic acid) 81 mg, cleared for dental treatment?

Medical Clearance for Dental Treatment After TIA

This patient is medically cleared for routine dental treatment, but blood pressure must be controlled below 180/110 mmHg before proceeding, and aspirin should be continued throughout the procedure. 1

Blood Pressure Control Requirements

The patient's hypertension must be adequately controlled before dental treatment can proceed safely. 1 Specifically:

• Dental care should be limited or deferred in patients with severe hypertension (typically defined as BP ≥180/110 mmHg) 1
• Since this patient had "uncontrolled hypertension" at hospital admission six weeks ago, verify current blood pressure readings before clearance 1
• The lisinopril dose was appropriately increased from 2.5 mg to 5 mg, but confirm therapeutic response with current BP measurement 2
• If BP remains ≥180/110 mmHg, defer elective dental procedures until better control is achieved 1
• For BP <180/110 mmHg, routine dental treatment may proceed with periodic BP monitoring during the appointment 1

Antiplatelet Management for Dental Procedures

Continue aspirin 81 mg daily without interruption for routine dental procedures. 3 The management approach is:

• The patient is currently on aspirin 81 mg monotherapy (appropriate long-term secondary prevention after the acute 21-30 day dual antiplatelet period has passed) 3
• Do not stop aspirin for routine dental work, including extractions and periodontal procedures 3
• The bleeding risk from continuing aspirin is substantially lower than the thrombotic risk from stopping it in this high-risk patient with recent TIA 3
• Local hemostatic measures (pressure, sutures, hemostatic agents) are sufficient to manage any increased bleeding 1

Critical Timing Considerations

This patient is six weeks post-TIA, which places him beyond the acute dual antiplatelet therapy window but in a critical secondary prevention phase:

• Dual antiplatelet therapy (aspirin + clopidogrel) is only indicated for 21-30 days after high-risk TIA 3
• At six weeks, he should be on aspirin monotherapy (81 mg daily) for long-term secondary stroke prevention 3, 4
• His stroke recurrence risk remains elevated at approximately 4% annually, making uninterrupted antiplatelet therapy essential 2

Common Pitfalls to Avoid

Never discontinue aspirin for routine dental procedures in TIA patients - the thrombotic risk far exceeds bleeding risk 3. Key warnings:

• Severe uncontrolled hypertension (BP ≥180/110 mmHg) is a contraindication to proceeding with elective dental work 1
• If the patient were still on dual antiplatelet therapy (aspirin + clopidogrel), this would also be acceptable for dental procedures without interruption 3
• Avoid recommending "bridging" strategies or temporary antiplatelet cessation - these are not indicated for dental work 3
• Do not confuse this scenario with anticoagulation management; aspirin carries minimal bleeding risk compared to warfarin 3

Pre-Procedure Checklist

Before providing clearance, confirm:

• Current blood pressure reading - must be <180/110 mmHg 1
• Patient is compliant with lisinopril 5 mg daily 2
• Patient is taking aspirin 81 mg daily (not clopidogrel, which should have been discontinued after 21-30 days) 3
• No active bleeding disorders or severe thrombocytopenia 3