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The final episode of bleeding is uncontrollable events that may be dangerous severe after treatment of non-surgical periodontal routine. Bleeding can lead to hypovolaemic shock, and could be critical. Although severe bleeding in patients taking aspirin is a familiar phenomenon (McGaul 1978, Thomason et al. 1997), incidence of shock impact of bleeding has not been previously reported. The main risk factors for the events unwanted biggest likely to be anti-platelet drugs given to patients. A recent systematic review of drug-anti-platelet drugs in dentistry summarizes the risk for bleeding in dental patients. The combination of aspirin and klopidogrel not discussed (Brennan et al. 2007). 
Because of the lack of information about the anti-platelets in addition to aspirin, the case presented here could be an early warning about the risk for bleeding after dental treatment in patients given anti-platelet regimen double. There is no reason to avoid dental treatment for patients who are taking anti-platelet, because it seems hypovolaemic shock is a rare complication. In addition, during the first bleeding episode, scaling done on the upper and lower quadrants while the bleeding occurred only in the area of teeth numbers 25-26.
ASA is the only anti-inflammatory drugs non-steroidal used in the treatment and prevention of thromboembolic disease (Bennett 2001). ASA irreversibly deactivate the enzymes siklooksigenase. This enzyme is responsible for the formation of prostaglandins and tromboksana A2, which is involved in platelet activation and aggregation mechanism (Schror 1997). As a result, ASA therapy associated with increased bleeding time. Klopidogrel is a derivative thienpyridin, a powerful inhibitor of platelet inhibition caused by ADP (Daniel et al., 2002). Addition klopidogrel into ASA therapy are known to increase bleeding complications (Diener et al. 2004). (more…)
