Clinical Trial Evaluating the Risk of Thromboembolic Events During Dental Extractions

Abstract

Dental extractions can be safely carried out in patients on anti-platelet therapy without the risk of significant post-extraction bleeding thus averting the risk of thromboembolic events that might take place on temporary discontinuation of antiplatelet therapy.

Should Antiplatelet Drugs Stopped Before Dental Extraction?

“…Although it is known that the dual use of these agents significantly decreases the risk of thromboembolism, it has also been stated that patients receiving dual therapy have a significant risk of hemorrhage during dental surgical procedures. 7 In this present study, hemorrhage rate was similar among the subgroups as one patient on acetylsalicylic acid subgroup, one patient on clopidogrel subgroup, and two patients on dual therapy subgroup. Extraction sockets were packed with gelatin sponges after granulation tissue was curetted following the dental extractions, and a dry gauze compress was applied for 10 minutes in this study as a standard protocol described in literature.…”

“…14 A previous literature review showed that there is a very limited number of studies evaluating the hemorrhage risk at the same times as major or minor operations take place, even if it's a simple dental extraction. 7,[15][16][17] Eighty-two patients who underwent a single or multiple dental extraction operations were evaluated by Krishan et al 17 researchers reported that they did not encounter any prolonged hemorrhage, and they concluded that it is unnecessary to interrupt antiplatelet therapy before simple dental extractions.…”

“…Moreover, there are very few studies focusing on the difference between patients who received monotherapy and patients who received dual therapy. 7,8 We hypothesized that there would not be any breakthrough or delayed bleeding after the dental extractions performed on patients who kept receiving antiplatelet therapy with acetylsalicylic acid or acetylsalicylic acid plus clopidogrel. Developing and implementing a standard therapy protocol prior to dental extraction for these patients is very important, as this continues to be a challenging decision for clinicians.…”

Antiplatelet therapy in patients undergoing oral surgery: A systematic review and meta-analysis

“…20 articles were deemed potentially relevant. Once the full text was analyzed, a total of 5 articles were included in this review: Gaspar, 1999 (17); Ardekian, 2000 (18); Medeiros, 2011 (19); Varghese 2015 (20) and Sadhasivam 2016 (21) ( Table 2, Table 2 continue: Characteristics of included studies). Of the 20 articles in which its full text was reviewed, 15 were excluded from this review as they didn´t meet the inclusion criteria ( Table 3, Table 3 continue).…”

“…Of the 20 articles in which its full text was reviewed, 15 were excluded from this review as they didn´t meet the inclusion criteria ( Table 3, Table 3 continue). From the included studies, 2 were conducted in Israel (17,18), 1 in Brazil (19), 2 in India (20,21). Only one specifies in which setting it was conducted, being that, a medical center (18).…”