acetylsalicylic acid for secondary prevention of cardiovascular events and post extraction haemorrhage

shutterstock_2092494 Dentist and assistant are examining you the patient

In patients who use acetylsalicylic acid (ASA) for the primary and secondary prevention of cardiovascular events some dentists recommend suspending its use before dental procedures to reduce bleeding. However, this potentially increases the risk of thromboembolic events. The effect of ASA on the amount of bleeding that occurs during tooth extraction procedures is controversial, and perioperative guidelines recommend that ASA administration should not be altered for such procedures.

The aim of this study was to evaluate the amount of bleeding that occurs during the intraoperative period of tooth extraction procedures in patients with coronary artery disease who are either undergoing acetylsalicylic acid (ASA) therapy or who have been instructed to suspend their ASA use.

Sixty-three patients with coronary artery disease receiving 100 mg/d of ASA who required tooth extraction were randomised to 2 groups:  In the test group (S) SA therapy was suspended 7 days before tooth extraction; For the control group (NS) ASA therapy was unaltered.

A platelet aggregation test was carried out on the day of the operation, and the amount of bleeding was measured during the intraoperative period by means of aspirated blood collection. All the extractions were performed by the same surgeon, who was unaware of whether the patient’s ASA therapy had been suspended.

They found
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  • Local hemostatic methods were sufficient to control bleeding, and there were no reported episodes of hemorrhaging during the intra- and postoperative periods.
  • The platelet reactivity index values exhibited statistically significant differences between the groups.

They concluded

There was no difference in the amount of bleeding that occurred during tooth extraction between patients who continued ASA therapy versus patients who suspended their ASA therapy. The platelet reactivity test demonstrated a reduction in platelet aggregation in the ASA therapy group (group NS), but this reduction was without clinical consequence.

Bleeding Evaluation During Single Tooth Extraction in Patients With Coronary Artery Disease and Acetylsalicylic Acid Therapy Suspension: A Prospective, Double-Blinded, and Randomized Study. Medeiros FB, de Andrade AC, Angelis GA, Conrado VC, Timerman L, Farsky P, Dib LL.J Oral Maxillofac Surg. 2011 Jul 28. [Epub ahead of print]PMID:21802823



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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