Risk of postoperative bleeding after dental extraction in patients on antiplatelet therapy: systematic review and meta-analysis

AlAgil, Jumana; AlDaamah, Ziyad; Khan, Assad; Omar, Omar

doi:10.1016/j.oooo.2023.10.006

Cited by 1 publication

(2 citation statements)

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“…Acetylsalicylic acid is absorbed in the stomach and reaches the bloodstream within 10 minutes, attaining peak plasma concentration between 30 to 40 minutes [14]. Aspirin functions by deactivating the enzyme cyclo-oxygenase, essential for thromboxane synthesis within platelets, thereby diminishing platelet activation and aggregation [15]. Conversely, clopidogrel serves as an adenosine diphosphate (ADP) antagonist, exerting its effects by irreversibly blocking the ADP receptor on the platelet membrane, leading to alterations in platelet morphology and decreased aggregation [16].…”

Section: Controlmentioning

confidence: 99%

“…According to guidelines from the American College of Cardiology Foundation and the American Heart Association, DAPT may be recommended for the secondary prevention of acute coronary events and post-stent placement [17]. Patients taking cardioaspirin or clopidogrel had almost the same bleeding time, conversely patients taking a combination of the two drugs presented an almost double bleeding time [15].…”

Section: Controlmentioning

confidence: 99%

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Effect of Different Anticoagulants and Antiplatelets on Intraoral Bleeding Time during Professional Oral Hygiene Session

Pesce,

Pin,

et al. 2024

Preprint

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Background: Patients with thromboembolic disease, prosthetic valves, or coagulation issues are commonly prescribed anticoagulants and antiplatelets. Although common professional oral hygiene might not represent a health concern for these patients, anticoagulant and antiplatelet medication might constitute a challenge for dentists and dental hygienists since possible prolonged bleeding might interfere with dental procedures. The aim of the present study was to investigate the bleeding time of different anticoagulants and antiplatelets during a professional hygiene session adapting the Ivy test to the oral environment; Methods: 93 consecutive patients undergoing professional oral hygiene were recruited. Debridement during oral hygiene was performed using ultrasonic mechanical instrumentation, and bleeding sites were assessed and treated with gentle pressure using sterile gauzes. The time for bleeding cessation was recorded. Patients were categorized into six groups based on their drug intake, Control: no anticoagulants or antiplatelets DTI: direct thrombin inhibitors (dabigatran) AntiXa: directa factor Xa inhibitors (endoxaban, apixaban, rivaroxaban) VKA: vitamin K antagonists (warfarin, acenocoumarol) SAPT: single anti-platelet therapy (acetylsalicylic acid or clopidogrel) DAPT: dual anti-platelet therapy (acetylsalicylic acid and clopidogrel). Bleeding time was measured in seconds and mean values were assessed among the different groups. Differences between groups were investigated with Kruskal-Wallis test followed by Dunn’s post-hoc correction for multiple comparisons or two-way ANOVA followed by Dunnett post-hoc; Results: Control patients presented the lowest bleeding time 50 sec, followed by AntiXa (98), SAPT (105), DTI (120), DAPT (190) and VKA (203). A statistically significant difference was present among control and DTI (p=0.004), VKA (p&lt;0.001), DAPT (p&lt;0.001). Conclusions: Based on the present outcomes, an increased risk of prolonged bleeding emerged in patients taking VKA and DAPT. However, bleeding did not interfere with the oral hygiene ses-sion The optimal period for dental treatment of these patients should be 2-3 hours before the next dose, without the need to temporarily suspend the medication.

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Section: Controlmentioning

confidence: 99%

Section: Controlmentioning

confidence: 99%