Aspirin Use and Post-operative Bleeding from Dental Extractions

Abstract

Aspirin is a common, chronically administered preventive treatment for cardiovascular disease, but is often discontinued prior to invasive dental procedures because of concern for bleeding complications. We hypothesized that aspirin does not cause increased bleeding following a single tooth extraction. Thirty-six healthy persons requiring a tooth extraction were randomized to receive 325 mg/day aspirin or placebo for 4 days. Cutaneous bleeding time (BT) and platelet aggregation tests were obtained prior to extraction. The primary outcome measure, oral BT, and secondary bleeding outcomes were evaluated during and following extraction. No significant baseline differences, except for diastolic blood pressure, were found between groups. There were no differences in oral BT, cutaneous BT, secondary outcome measures, or compliance. Whole-blood aggregation results were significantly different between the aspirin and placebo groups. These findings suggest that there is no indication to discontinue aspirin for persons requiring single-tooth extraction.

Gestion péri-opératoire des patients traités par antithrombotiques en chirurgie orale. Argumentaire

“…Pour l'ensemble de ces études cliniques [24,36,48,50,54,56,113,185,197,204,228,234,248,281], aucune complication hémorragique sévère non contrôlable par des mesures d'hémostase locale n'est rapportée. Deux études [212,237] ont évalué la perte sanguine après extraction dentaire chez des patients sous aspirine ou clopidogrel comparativement à des patients ne prenant pas d'aspirine ou ayant interrompu leur traitement par AAP 7 jours avant la procédure dentaire ou sous AINS.…”

“…• En cas d'extraction simple (unitaire et multiple), les mesures d'hémostase conventionnelles (sutures + compression mécanique de 30 minutes) sont efficaces et suffisantes pour contrôler le saignement postopératoire chez les patients sous aspirine [24,50,185,204,281] ou sous clopidogrel [54,197] avec un taux de saignement postopératoire rési-duel acceptable d'environ 2 à 3 %. Sous bithérapie aspirine + clopidogrel, une hémostase locale associant sutures + compression semble insuffisante [197] [54,197,227].…”

An Assessment of the Incidence of Prolonged Postoperative Bleeding After Dental Extraction Among Patients on Uninterrupted Low Dose Aspirin Therapy and to Evaluate the Need to Stop Such Medication Prior to Dental Extractions

“…Local measures are sufficient to control any bleeding during surgery. Brennan et al [2] also conducted a study on 36 patients on aspirin, and found and suggested that there is no indication for discontinuing aspirin for individuals requiring a single-tooth extraction, or similarly invasive dental procedures.…”

Extração dentária em pacientes com doença arterial coronariana em terapia antiplaquetária dual

“…Nos dias atuais, há um aumento no número de pessoas portadoras de cardiopatias, não apenas pelo fato do diagnóstico precoce e/ou aumento da sobrevida da população, mas também pelo crescente aumento dos fatores de risco cardiovascular, como sedentarismo, tabagismo, hipertensão, dislipidemia, diabetes Durante algum tempo as pesquisas clínicas se ocuparam de comprovar e assegurar ao cirurgião dentista clínico que a utilização de AAS não configura um risco de hemorragias incontroláveis durante procedimentos odontológicos invasivos (Medeiros et al, 2011 A situação ideal, ao submeter um paciente sob terapia antiplaquetária dual a um procedimento odontológico invasivo, seria, teoricamente, contar com exames de agregação plaquetária, para poder avaliar o risco de hemorragia transoperatória e recomendar, se necessário, tratamento em nível hospitalar (Brennan et al, 2008;Morimoto et al, 2009;Morimoto et al, 2011;Fakhri et al, 2013 McKay et al, 2004, Zhou;Schmaier, 2005, Neunert;Journeycake, 2007, Rezende et al, 2010.…”

“…Por outro lado, (Brennan et al, 2008;Minematsu, 2009;Morimoto et al, 2011;Fakhri et al, 2013) (Grines et al, 2007). Isto faz com que muitos profissionais recomendem a suspensão da medicação antes de qualquer procedimento cirúrgico odontológico, entretanto, a suspensão desta terapia expõe os pacientes portadores de stent coronariano à riscos adversos de eventos trombóticos.…”