Dental Extraction Can Be Performed Safely in Patients on Aspirin Therapy: A Timely Reminder

Abstract

Cardiac patients on aspirin therapy may require extractions for their diseased teeth. It is a common practice among physicians and treating surgeons to stop aspirin prior to tooth extraction because of fear of bleeding complications. This practice often predisposes the patient to adverse thromboembolic events. This practice is based on theoretical risk of bleeding and on isolated case reports of excessive bleeding with aspirin therapy. The current consensus and recommendations are in favor of continuing aspirin therapy during simple tooth extraction as the bleeding complication incidence is very less and if it occurs can be controlled efficiently with local hemostasis measures.

Bleeding in Dental Surgery

“…• Supplemental patient-related risk determinants: diabetes mellitus, hypertension, obesity, hemostatic disorders, renal impairment, and other major organ system failures [73][74][75].…”

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].…”

“…Aframian, 2007 [1], Ardekian, 2000 [24], Bajkin, 2012 [35], Bajkin, 2015[36], Brennan,2008[49],Canigral,2008 [54]Cardona-Tortajada, 2009 [56], Garnier, 2007 [113], Iwabuchi, 2014 [173], Krishman, 2008 [185], Lillis, 2011 [197], Madan, 2010 [204],] Medeiros, 2011 [212], Moritomoto, 2008a [223], Morimoto, 2011 [225], Napenas, 2009 [227], Olmos-Carrasco, 2015 [234], Park, 2012 [239], Partridge, 2008 [237], Rai, 2013 [248], van Diermen, 2009 [278], Verma, 2013 [280], Verma, 2014 [281] Etape 3 «Antiplatelet» OU " «Aspirin» OU «Dipyridamol» OU «Ticlopidin»OU«Clopidogrel»OU«Prasugrel»OU«Ticagrelor» "ET" « Dental implant »…”

Bleeding disorders in dental practice: A diagnostic overview

“…Oral, periodontal, and locally, so discontinuation of anti-platelet therapy is not recommended. [11][12][13] According to the recently published POISE-2 study on aspirin in patients undergoing noncardiac elective surgery; "Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding." [14] CONCLUSION • A number of surgical procedures including those per formed in dentistr y may cause bleeding.…”