Dental extraction without stopping single or dual antiplatelet therapy: results of a retrospective cohort study

Lu, Shin-Yu; Tsai, Chi-Yu; Lin, Li-Yan

doi:10.1016/j.ijom.2016.02.010

Cited by 40 publications

(43 citation statements)

References 27 publications

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“…Some studies have shown no significant difference in the risk of bleeding following dental extraction [3,11,16], dental osteotomy [5], or minor oral surgical procedures [7] between patients who continue aspirin therapy and those who do not use aspirin. Others have contradictorily found an increased bleeding risk after dental extraction [4,8,12] and minor surgical procedures [25], though the risk measures were not statistically significant [8,12,25]. In the present study, clinical evidence of an increased risk along with statistical significance (RR, 4.5; 95% CI, 2.0 to 10.0; p <0.001) strongly suggested that bleeding following minor oral surgical procedures was more likely to occur in high-risk patients or patients with existing chronic diseases with continued aspirin therapy compared to general patients who did not use aspirin during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The paradigm for minor oral surgery of patients with long-term aspirin therapy has consequently shifted towards accepting the continuation of aspirin use during surgery and providing similarly practiced procedures to those performed on general patients who do not use aspirin. However, a higher incidence of prolonged bleeding following minor oral surgery in patients with uninterrupted aspirin use compared to those who do not use aspirin during surgery has still been observed in practice-based cohort studies [8,12]. Patients prescribed aspirin therapy, in reality, are also more likely to present as high-risk or with existing chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have previously contributed to estimating the bleeding risk specific to dental extractions [3,8,10-12,16], yet only a few have investigated the risk in dental osteotomy [5] or minor oral surgical procedures [7]. Information regarding the overall bleeding risk in patients that undergo various surgical procedures in general dental practice, therefore, remains missing.…”

Section: Introductionmentioning

confidence: 99%

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Risk of Hemorrhage Attributed to Underlying Chronic Diseases and Uninterrupted Aspirin Therapy of Patients Undergoing Minor Oral Surgical Procedures: A Retrospective Cohort Study

Rojanaworarit

Limsawan²

2017

J Prev Med Public Health

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ObjectivesThis study aimed to estimate the risk of bleeding following minor oral surgical procedures and uninterrupted aspirin therapy in high-risk patients or patients with existing chronic diseases compared to patients who did not use aspirin during minor oral surgery at a public hospital.MethodsThis retrospective cohort study analyzed the data of 2912 patients, aged 20 years or older, who underwent 5251 minor oral surgical procedures at a district hospital in Thailand. The aspirin group was comprised of patients continuing aspirin therapy during oral surgery. The non-aspirin group (reference) included all those who did not use aspirin during surgery. Immediate and late-onset bleeding was evaluated in each procedure. The risk ratio of bleeding was estimated using a multilevel Poisson regression.ResultsThe overall cumulative incidence of immediate bleeding was 1.3% of total procedures. No late-onset bleeding was found. A significantly greater incidence of bleeding was found in the aspirin group (5.8% of procedures, p<0.001). After adjusting for covariates, a multilevel Poisson regression model estimated that the bleeding risk in the aspirin group was 4.5 times higher than that of the non-aspirin group (95% confidence interval, 2.0 to 10.0; p<0.001). However, all bleeding events were controlled by simple hemostatic measures.ConclusionsHigh-risk patients or patients with existing chronic diseases who continued aspirin therapy following minor oral surgery were at a higher risk of hemorrhage than general patients who had not used aspirin. Nonetheless, bleeding complications were not life-threatening and could be promptly managed by simple hemostatic measures. The procedures could therefore be provided with an awareness of increased bleeding risk, prepared hemostatic measures, and postoperative monitoring, without the need for discontinuing aspirin, which could lead to more serious complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of Hemorrhage Attributed to Underlying Chronic Diseases and Uninterrupted Aspirin Therapy of Patients Undergoing Minor Oral Surgical Procedures: A Retrospective Cohort Study

Rojanaworarit

Limsawan²

2017

J Prev Med Public Health

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“…For dental applications, TXA 2 activity is relevant for the care of dental extraction patients. As TXA 2 is a potent activator of platelet aggregation, special care needs to be taken with regard to prescribing aspirin (Nizarali and Rafique, 2013) or interrupting antiplatelet therapy (Lu et al, 2016). Additionally, gingival TXB 2 levels have long been known to be elevated in animal models of periodontal disease (Rifkin and Tai, 1981).…”

Section: Prostaglandinsmentioning

confidence: 99%

Regulation of inflammation by lipid mediators in oral diseases

Sommakia

Baker

2016

Oral Diseases

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Lipid mediators (LM) of inflammation are a class of compounds derived from ω-3 and ω-6 fatty acids that play a wide role in modulating inflammatory responses. Some LM possess pro-inflammatory properties, while others possess pro-resolving characteristics, and the class switch from pro-inflammatory to pro-resolving is crucial for tissue homeostasis. In this article, we review the major classes of LM, focusing on their biosynthesis and signaling pathways, and their role in systemic and, especially, oral health and disease. We discuss the detection of these LM in various body fluids, focusing on diagnostic and therapeutic applications. We also present data showing gender-related differences in salivary LM levels in healthy controls, leading to a hypothesis on the etiology of inflammatory diseases, particularly, Sjögren’s Syndrome. We conclude by enumerating open areas of research where further investigation of LM is likely to result in therapeutic and diagnostic advances.

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“…Mind a fejlett nyugat-európai országok, mind az Amerikai Egyesült Államok protokolljai az antikoaguláns kezelésben részesült betegeknél -minimális eltéréssel a mért INR-érték függvényében -egyértelmű összhang-ban vannak, amely szerint 2,0-4,0 értékekig a gyógy-szerszedést folytatva, átállítás nélkül kell a szükséges fogorvosi/szájsebészeti beavatkozást elvégezni, hangsú-lyozva a megfelelő sebellátást, lokális vérzéscsillapító módszerek alkalmazását [2,3,6,[10][11][12]. A minimálisan szükséges rutin fogorvosi vérzéscsillapító ellátás lépéseit a 3. ábrán mutatjuk be.…”

Section: Megbeszélésunclassified

A gyógyszer indukálta vérzékeny betegek fogorvosi, szájsebészeti ellátása: a 2015-ös hazai szakmai ajánlás alkalmazása és értékelése

et al. 2016

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Pécs 2 Semmelweis Egyetem, Fogorvostudományi Kar, Arc-, Állcsont-, Szájsebészeti és Fogászati Klinika, BudapestBevezetés: A Magyar Arc-, Állcsont-és Szájsebészeti Társaság és a Magyar Fogorvosok Implantológiai Társasága által 2015-ben elfogadásra került "A gyógyszer indukálta vérzékeny betegek fogorvosi ellátása" szakmai ajánlás. Célkitű-zés: A szerzők célja volt az ajánlásban leírt lokális vérzéscsillapítási módszerek hatékonyságának, megbízhatóságának ellenőrzése. Módszer: Az orális antithromboticus kezelésben részesülő betegeiknél vizsgálták a fogorvosi, szájsebésze-ti ellátásukat követő utóvérzések előfordulását, retrospektív módon. Eredmények: 263, vérzéssel járó beavatkozás történt (186 betegnél), amelyből 138 K-vitamin-antagonista, 97 thrombocytaaggregáció-gátló és 6, úgynevezett új típusú orális antikoaguláns kezelésben részesülő betegeknél. Összesen 6 (2,3%) esetben tapasztaltak utóvérzést az egyórás kontrollnál, míg ügyeletbe 1 beteg jött vissza utóvérzés miatt (0,5%). Ezzel szemben 86-an jelentkeztek ügyeletükön, akiknél az ajánlást nem vették figyelembe, közülük K-vitamin-antagonista gyógyszert szedett 3 beteg, alacsony molekulasúlyú heparinkezelésben részesült 24 beteg, thrombocytaaggregáció-gátló szert szedett 30 beteg és új típusú orális antikoaguláns kezelésben részesült 1 beteg. Következtetések: A hazai szakmai ajánlás az ambuláns gyakorlatban biztonságosan alkalmazható az antithromboticus terápiában részesülő páciensek vérzéssel járó fogorvosi/szájsebészeti beavatkozásakor, habár a körzetes fogorvos ellátók sok esetben nincsenek ilyen jellegű ellátásra felké-szülve.

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Dental extraction without stopping single or dual antiplatelet therapy: results of a retrospective cohort study

Cited by 40 publications

References 27 publications

Risk of Hemorrhage Attributed to Underlying Chronic Diseases and Uninterrupted Aspirin Therapy of Patients Undergoing Minor Oral Surgical Procedures: A Retrospective Cohort Study

Risk of Hemorrhage Attributed to Underlying Chronic Diseases and Uninterrupted Aspirin Therapy of Patients Undergoing Minor Oral Surgical Procedures: A Retrospective Cohort Study

Regulation of inflammation by lipid mediators in oral diseases

A gyógyszer indukálta vérzékeny betegek fogorvosi, szájsebészeti ellátása: a 2015-ös hazai szakmai ajánlás alkalmazása és értékelése

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