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).
There are several studies that suggest that patients stop using ASA 5-10 days before surgery to prevent post-operative bleeding (Bick 1976, Michelson et al. 1978, Torosian et al. 1978, Komatsu et al. 2005). The others did not report a significant increase in blood loss in patients who continued ASA (Bartlett 1999, Ardekian et al., 2000, Daniel et al. 2002, Madan et al. 2005). In our case, discontinuance of the anti-platelet agents are not recommended prior to periodontal treatment. The reason for the continuing anti-platelet treatment is to minimize the risk of complications trombotik and embolik (Fischer et al. 2004). With topical armantarium hemostatik available and needed lots of maintenance procedures in patients with severe periodontal disease, the regimen is appropriate.
In the reported cases, coagulation tests and platelet normal. Test platelet function (platelet) was not done because this is a post-operative bleeding and the slow phase is not associated with platelet coagulation. The patient had no signs of bleeding at the end of periodontal procedures and bleeding occurred several hours later.
Pathogenesis episodes of severe bleeding may be caused by many factors. Primary effect of anti-platelet therapy is the initial component of the freezing mechanism. A large blood clot, which involved the examination could be hiding places for local fibrinolitik process (Sindet-Pedersen 19,091). It is known that thrombosis and fibrinolysis related. So when there is a large clot, then there is a stronger trigger for fibrinolysis. As a result, the membrane covering trombotik a misunderstood anti-trombotik recess internally. Local trauma can also trigger secondary bleeding. Diabetes mellitus can also affect the vulnerability of the vascular wall (McMillan 1997).
Introduction of anti-platelet drugs only, such as absiksimab, epitifibatida and tirofiban, causing the need for evidence-based data that will assess the risk of bleeding during oral surgical intervention and non-surgical.
In summary, the literature on post-operative bleeding after anti-platelet drugs primarily related to the surgical procedure. Of the cases reported here, we suggest that physicians should always be aware of post-operative bleeding severe end of the treatment of non-surgical periodontal patients who received anti-platelet drugs. Systematic review of the latest recommendation is not to stop aspirin before routine tooth extraction (Brennan et al., 2007). These recommendations appear to be suitable for the management of non-surgical procedures such as periodontal scaling and root planing. The combination of anti-platelet treatment could provide pharmacological greater risk than previously thought. Oral health care providers need to know the importance of local hemostasis in patients at risk for experiencing post-operative bleeding.
Tags: anti-platelet drugs, aspirin, bleeding, hypovolaemic shock, Periodontal, Periodontal Routine, Surgical, Surgical Periodontal Routine, thromboembolic disease
