Evaluation of bleeding following dental extraction in patients on long-term antiplatelet therapy: A clinical trial

Abstract

Hence, we recommend routine single tooth extractions in patients on long-term antiplatelet medication, without interruption or alteration of their medication. Such patients do not have an increased risk of prolonged or excessive postoperative bleeding.

Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?

“…In a study performed in the United States, 25 transfusion support was required during four transurethral resection procedures of bladder cancer performed in patients who used antiplatelet therapy in the perioperative period and during two procedures for the control group ( P =0.242). In another study 22 carried out in India, none of the patients subjected to dental extraction had uncontrollable bleeding after the procedure, a result seen both in the group that used interrupted antiplatelet therapy and in the group that had the therapy 5 days before the surgical procedure. In both studies, no cardiac events or complications related to anesthesia occurred in the evaluated patients nor was there a need to rehospitalize any of them.…”

“…The sample size of each study varied a little: there was an article covering 160 patients to one study with 1,121 patients, but the age group was similar in all studies, from 61 to 75 years. The most frequent surgery was related to tooth extraction 22 – 24 and transurethral resection of bladder cancer. 25 Acetylsalicylic acid (ASA) was the common drug in all studies.…”

“…Regarding the limitations of the studies, they were not reported in two of them, 22 , 25 however, the study carried out in Serbia 23 pointed out as limitations, the fact that the sample is small, and the surgical procedures performed are low risk of bleeding (single and multiple dental extractions). On the other hand, the study carried out in India by Girotra et al 24 determined as a limitation the fact that the platelet aggregation test was not used because it was very expressive, as well as the nonquantification of intraoperative bleeding to estimate and compare blood loss between the study group and control group.…”

“…In our systematic review, the four selected clinical trials evaluated the risk of perioperative bleeding with ASA or clopidogrel alone, and one of them also evaluated the use of ticoplidina; 23 two of them also assessed the risk of bleeding with dual antiaggregation therapies (aspirin + clopidogrel, aspirin + ticlopidine, and aspirin + prasugrel). 22 , 23 In all the trials, it was concluded that there is no need to suspend the medications prior to procedures such as dental extraction and transurethral resection of the bladder, because according to these studies there is no need to expose the patient to the risk of thromboembolism, cerebrovascular accidents or AMI interrupting the platelet antiaggregation therapy prior to small surgical procedures. 22 – 25 …”

“… 22 , 23 In all the trials, it was concluded that there is no need to suspend the medications prior to procedures such as dental extraction and transurethral resection of the bladder, because according to these studies there is no need to expose the patient to the risk of thromboembolism, cerebrovascular accidents or AMI interrupting the platelet antiaggregation therapy prior to small surgical procedures. 22 – 25 …”