Should patients with antiphospholipid antibodies be given antibiotic prophylaxis prior to dental urologic and gastrointestinal procedures?
Patients with APLs may have underlying valvular disease that could theoretically predispose them to endocarditis following procedures known to cause transient bacteremia. Nonetheless, data has not supported a role for antibiotic prophylaxis for the majority of patients with valvular heart disease, and only a subset of patients with the following conditions should routinely receive antibiotics:
- – Prosthetic valves and/or prosthetic materials used for valve repair (e.g., annuloplasty rings, prosthetic material used in repair of congenital heart defects).
- – History of infective endocarditis.
- – History of cardiac transplant with valve regurgitation.
- – Unrepaired cyanotic congenital heart defects.
It is important to note that even among these high-risk groups, prophylactic antibiotics are not recommended for low-risk dental procedures such as routine cleaning and are reserved for procedures which manipulate gingival tissue, the periapical area of teeth or perforate the oral mucosa. Current guidelines do not outline formal recommendations for patients with APLs and known valvular abnormalities, and clinical data regarding antibiotic prophylaxis in this group is limited. As such, clinical judgement should be used regarding this decision and should take into consideration the risk of infection overall in patients with rheumatic conditions on immunosuppression.