EVALUATION OF THE RISK OF POST EXTRACTION BLEEDING IN PATIENTS USING ASPIRIN
Main Article Content
Keywords
Dental extraction, Post-extraction bleeding, Aspirin
Abstract
Introduction: Antiplatelet medications, including aspirin, play a crucial role in preventing thrombotic events by reducing platelet aggregation. Aspirin is commonly used for long-term cardiovascular protection but is often discontinued before invasive dental procedures due to concerns about excessive bleeding. However, the necessity of stopping aspirin before dental extractions remains unclear.
Objectives: This study aimed to evaluate the risk of post-operative bleeding after dental extractions in patients on aspirin therapy and to determine whether discontinuation of the medication is necessary before the procedure.
Methods: This cross-sectional study was conducted in the Department of Oral & Maxillofacial Surgery at Foundation University College of Dentistry and Hospital (FUCD&H), Islamabad, from December 1, 2021, to November 30, 2022. A total of 390 patients requiring dental extractions were included. Patients on aspirin (75–100 mg) continued their medication. Tooth extractions were performed under local anesthesia, and post-extraction bleeding was assessed at 30 minutes and after 24 hours. Persistent bleeding was managed with additional pressure packs.
Results: The mean age of participants was 65.74 ± 10.52 years, with 184 (47.2%) males and 206 (52.8%) females. The mean duration of aspirin use was 4.23 ± 2.09 years. No cases of post-operative bleeding were observed among patients taking aspirin.
Conclusion: The findings suggest that aspirin can be safely continued during dental extractions without increasing the risk of post-operative bleeding, preventing unnecessary discontinuation and reducing the potential for thromboembolic complications.
Objectives: This study aimed to evaluate the risk of post-operative bleeding after dental extractions in patients on aspirin therapy and to determine whether discontinuation of the medication is necessary before the procedure.
Methods: This cross-sectional study was conducted in the Department of Oral & Maxillofacial Surgery at Foundation University College of Dentistry and Hospital (FUCD&H), Islamabad, from December 1, 2021, to November 30, 2022. A total of 390 patients requiring dental extractions were included. Patients on aspirin (75–100 mg) continued their medication. Tooth extractions were performed under local anesthesia, and post-extraction bleeding was assessed at 30 minutes and after 24 hours. Persistent bleeding was managed with additional pressure packs.
Results: The mean age of participants was 65.74 ± 10.52 years, with 184 (47.2%) males and 206 (52.8%) females. The mean duration of aspirin use was 4.23 ± 2.09 years. No cases of post-operative bleeding were observed among patients taking aspirin.
Conclusion: The findings suggest that aspirin can be safely continued during dental extractions without increasing the risk of post-operative bleeding, preventing unnecessary discontinuation and reducing the potential for thromboembolic complications.
References
1. Saxena A, Kumar GA, Hiralkar P, Mahajan SB, Rubeena S, Tabasum D. Evaluation of Post Extraction Bleeding on Aspirin Patient-A Clinical Study. Saudi Journal of Medicine. 2019;4(8):580-4.
2. AlAgil J, AlDaamah Z, Khan A, Omar O. Risk of postoperative bleeding after dental extraction in patients on antiplatelet therapy: systematic review and meta-analysis. Oral surgery, oral medicine, oral pathology and oral radiology. 2024 Mar 1;137(3):224-42.
3. AlSheef M, Gray J, AlShammari A. Risk of postoperative bleeding following dental extractions in patients on antithrombotic treatment. The Saudi Dental Journal. 2021 Nov 1;33(7):511-7.
4. Lewandowski B, Myszka A, Migut M, Czenczek-Lewandowska E, Brodowski R. Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study. BMC Oral Health. 2021 Dec;21:1-7.
5. Martínez-Moreno E, Martínez-López F, Rodríguez-Lozano FJ, Oñate-Sánchez RE. Bleeding complications in anticoagulated and/or antiplatelet-treated patients at the dental office: a retrospective study. International journal of environmental research and public health. 2021 Feb;18(4):1609.
6. Krishnan B, Prasad GA, Madhan B, Saravanan R, Mote NP, Akilesh R. Post-extraction bleeding complications in patients on uninterrupted dual antiplatelet therapy—a prospective study. Clinical Oral Investigations. 2021 Feb;25:507-14.
7. Rubino RT, Dawson III DR, Kryscio RJ, Al-Sabbagh M, Miller CS. Postoperative bleeding associated with antiplatelet and anticoagulant drugs: A retrospective study. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2019 Sep 1;128(3):243-9.
8. Campana MD, Aliberti A, Acerra A, Sammartino P, Dolce P, Sammartino G, Gasparro R. The effectiveness and safety of autologous platelet concentrates as hemostatic agents after tooth extraction in patients on anticoagulant therapy: a systematic review of Randomized, controlled trials. Journal of Clinical Medicine. 2023 Aug 17;12(16):5342.
9. Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. Jama. 2019 Jan 22;321(3):277-87.
10. Brancaccio Y, Antonelli A, Barone S, Bennardo F, Fortunato L, Giudice A. Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: A randomized clinical trial. Clinical Oral Investigations. 2021 Mar;25:1159-67.
11. Rocha AL, Oliveira SR, Souza AF, Travassos DV, Abreu LG, Ribeiro DD, Silva TA. Bleeding assessment in oral surgery: A cohort study comparing individuals on anticoagulant therapy and a non-anticoagulated group. Journal of Cranio-Maxillofacial Surgery. 2019 May 1;47(5):798-804.
12. Hiroshi I, Natsuko SY, Yutaka I, Masayori S, Hiroyuki N, Hirohisa I. Frequency of hemorrhage after tooth extraction in patients treated with a direct oral anticoagulant: A multicenter cross-sectional study. PLoS One. 2022 Apr 7;17(4):e0266011.
13. Ockerman A, Bornstein MM, Leung YY, Li SK, Politis C, Jacobs R. Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis. International journal of oral and maxillofacial surgery. 2020 Jan 1;49(1):90-8.
14. Mahady SE, Margolis KL, Chan A, Polekhina G, Woods RL, Wolfe R, Nelson MR, Lockery JE, Wood EM, Reid C, Ernst ME. Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut. 2021 Apr 1;70(4):717-24.
15. Giudice A, Esposito M, Bennardo F, Brancaccio Y, Buti J, Fortunato L. Dental extractions for patients on oral antiplatelet: a within-person randomised controlled trial comparing haemostatic plugs, advanced-platelet-rich fibrin (A-PRF+) plugs, leukocyte-and platelet-rich fibrin (L-PRF) plugs and suturing alone. International Journal of Oral Implantology. 2019 Jan 1;12(1).
16. Hua W, Huang Z, Huang Z. Bleeding outcomes after dental extraction in patients under direct-acting oral anticoagulants vs. vitamin K antagonists: a systematic review and meta-analysis. Frontiers in Pharmacology. 2021 Oct 28;12:702057.
17. Zabojszcz M, Malinowski KP, Janion-Sadowska A, Lillis T, Ziakas A, Sławska A, Janion M, Siudak Z. Safety of dental extractions in patients on dual antiplatelet therapy–a meta-analysis. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2019 Apr 4;15(1):68-73.
18. Lee JS, Kim MK, Kang SH. Effect of warfarin discontinuation on the incidence of postoperative bleeding in tooth extraction. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2020 Aug 31;46(4):228-34.
2. AlAgil J, AlDaamah Z, Khan A, Omar O. Risk of postoperative bleeding after dental extraction in patients on antiplatelet therapy: systematic review and meta-analysis. Oral surgery, oral medicine, oral pathology and oral radiology. 2024 Mar 1;137(3):224-42.
3. AlSheef M, Gray J, AlShammari A. Risk of postoperative bleeding following dental extractions in patients on antithrombotic treatment. The Saudi Dental Journal. 2021 Nov 1;33(7):511-7.
4. Lewandowski B, Myszka A, Migut M, Czenczek-Lewandowska E, Brodowski R. Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study. BMC Oral Health. 2021 Dec;21:1-7.
5. Martínez-Moreno E, Martínez-López F, Rodríguez-Lozano FJ, Oñate-Sánchez RE. Bleeding complications in anticoagulated and/or antiplatelet-treated patients at the dental office: a retrospective study. International journal of environmental research and public health. 2021 Feb;18(4):1609.
6. Krishnan B, Prasad GA, Madhan B, Saravanan R, Mote NP, Akilesh R. Post-extraction bleeding complications in patients on uninterrupted dual antiplatelet therapy—a prospective study. Clinical Oral Investigations. 2021 Feb;25:507-14.
7. Rubino RT, Dawson III DR, Kryscio RJ, Al-Sabbagh M, Miller CS. Postoperative bleeding associated with antiplatelet and anticoagulant drugs: A retrospective study. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2019 Sep 1;128(3):243-9.
8. Campana MD, Aliberti A, Acerra A, Sammartino P, Dolce P, Sammartino G, Gasparro R. The effectiveness and safety of autologous platelet concentrates as hemostatic agents after tooth extraction in patients on anticoagulant therapy: a systematic review of Randomized, controlled trials. Journal of Clinical Medicine. 2023 Aug 17;12(16):5342.
9. Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. Jama. 2019 Jan 22;321(3):277-87.
10. Brancaccio Y, Antonelli A, Barone S, Bennardo F, Fortunato L, Giudice A. Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: A randomized clinical trial. Clinical Oral Investigations. 2021 Mar;25:1159-67.
11. Rocha AL, Oliveira SR, Souza AF, Travassos DV, Abreu LG, Ribeiro DD, Silva TA. Bleeding assessment in oral surgery: A cohort study comparing individuals on anticoagulant therapy and a non-anticoagulated group. Journal of Cranio-Maxillofacial Surgery. 2019 May 1;47(5):798-804.
12. Hiroshi I, Natsuko SY, Yutaka I, Masayori S, Hiroyuki N, Hirohisa I. Frequency of hemorrhage after tooth extraction in patients treated with a direct oral anticoagulant: A multicenter cross-sectional study. PLoS One. 2022 Apr 7;17(4):e0266011.
13. Ockerman A, Bornstein MM, Leung YY, Li SK, Politis C, Jacobs R. Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis. International journal of oral and maxillofacial surgery. 2020 Jan 1;49(1):90-8.
14. Mahady SE, Margolis KL, Chan A, Polekhina G, Woods RL, Wolfe R, Nelson MR, Lockery JE, Wood EM, Reid C, Ernst ME. Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut. 2021 Apr 1;70(4):717-24.
15. Giudice A, Esposito M, Bennardo F, Brancaccio Y, Buti J, Fortunato L. Dental extractions for patients on oral antiplatelet: a within-person randomised controlled trial comparing haemostatic plugs, advanced-platelet-rich fibrin (A-PRF+) plugs, leukocyte-and platelet-rich fibrin (L-PRF) plugs and suturing alone. International Journal of Oral Implantology. 2019 Jan 1;12(1).
16. Hua W, Huang Z, Huang Z. Bleeding outcomes after dental extraction in patients under direct-acting oral anticoagulants vs. vitamin K antagonists: a systematic review and meta-analysis. Frontiers in Pharmacology. 2021 Oct 28;12:702057.
17. Zabojszcz M, Malinowski KP, Janion-Sadowska A, Lillis T, Ziakas A, Sławska A, Janion M, Siudak Z. Safety of dental extractions in patients on dual antiplatelet therapy–a meta-analysis. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2019 Apr 4;15(1):68-73.
18. Lee JS, Kim MK, Kang SH. Effect of warfarin discontinuation on the incidence of postoperative bleeding in tooth extraction. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2020 Aug 31;46(4):228-34.
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Published
Sep 15, 2024
Article Details
How to Cite
Ziad Muhammad, Muhammad Wasim Ibrahim, Nadia Zaman, Iram Rasheed, & Sadaf Raffi. (2024). EVALUATION OF THE RISK OF POST EXTRACTION BLEEDING IN PATIENTS USING ASPIRIN. Journal of Population Therapeutics and Clinical Pharmacology, 31(9), 3802-3808. https://doi.org/10.53555/kjsspx33
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Author Biographies
Ziad Muhammad
BDS, FCPS, Post Graduate Registrar, Department of Oral and Maxillofacial Surgery, Foundation University College of Dentistry, Islamabad, Pakistan
Muhammad Wasim Ibrahim
BDS, MCPS, FCPS, OMFS, Professor, Dean of Foundation University College of Dentistry, Islamabad, Pakistan
Nadia Zaman
BDS, FCPS, Professor, HOD, Department of Endodontics, Foundation University College of Dentistry, Islamabad, Pakistan
Iram Rasheed
BDS, FCPS, Post Graduate Registrar, Department of Oral and Maxillofacial Surgery, Foundation University College of Dentistry, Islamabad, Pakistan
Sadaf Raffi
BDS, MCPS, Senior Registrar, Department of Oral Medicine, Foundation University College of Dentistry, Islamabad, Pakistan
How to Cite
Ziad Muhammad, Muhammad Wasim Ibrahim, Nadia Zaman, Iram Rasheed, & Sadaf Raffi. (2024). EVALUATION OF THE RISK OF POST EXTRACTION BLEEDING IN PATIENTS USING ASPIRIN. Journal of Population Therapeutics and Clinical Pharmacology, 31(9), 3802-3808. https://doi.org/10.53555/kjsspx33