ABSTRACT
Aim:
The study was done to evaluate extraction of teeth without altering the aspirin therapy.
Materials and Method:
Hundred patients taking aspirin therapy requiring extraction of teeth were separated into two groups with 50 samples in each. Group I continued the aspirin therapy during extraction of teeth on one occasion, and the same patients who discontinued the aspirin therapy 72 hours before extraction of teeth on another occasion become Group II.
Result:
The mean blood loss showed slightly increased bleeding in Group I in comparison to Group II. The average bleeding time and mean INR was statistically significant among both groups. The mean clotting time and mean platelet count were not statistically significant among groups.
Conclusion:
There was no alteration in bleeding after extraction in patients with low doses of aspirin therapy.
KEYWORDS: Aspirin, extraction, low dose
INTRODUCTION
Low-dose aspirin 75–100 mg (systemic antiplatelet therapy) is commonly used to treat angina, post-myocardial infarction, ischemic heart disease, bypass surgery, stroke, transient ischemic attacks and post-angiography/angioplasty.[1] The risk of postoperative haemorrhage after extractions has long been a concern in the treatment of patients who are receiving antiplatelet therapy.[1,2]
Aspirin inhibits cyclooxygenase, interfering with the synthesis of prothrombotic TXA2, which is essential in the platelet activation cycle. Platelet adhesion, activation and aggregation are important steps in the formation of a thrombus, which explains the antithrombotic effect of aspirin in a simplified manner.[1,2] Since an antiplatelet effect may cause increased bleeding during and after extractions;[1] hence, there is a controversial issue regarding antiplatelet therapy for dental extraction.[3]
The objective of this research was to assess the extraction of teeth without altering the aspirin therapy.
MATERIALS AND METHODS
This case-control study was done in the Oral and Maxillofacial Surgery Department after obtaining ethical clearance from the institutional ethics committee and informed written consent from all the participants. A total of 100 patients were included and divided equally into two groups of 50 samples each. Group I continued 100 mg of aspirin therapy during extraction of teeth on one occasion, and in Group II the same patients stopped aspirin therapy 72 hours before the extraction of teeth.
The study was conducted to evaluate intraoperative blood loss along with bleeding time, clotting time, platelet count and INR during extraction of teeth in the age group of 50–70 years in the extraction of mandibular posterior teeth of chronic generalized periodontitis condition.
Extraction of single teeth was carried out in both groups. Prophylactic antibiotics were prescribed as per guidelines Classical inferior nerve block was given for all extractions, and no local infiltration was given at the surgical site. The surgical gauze was weighed both pre- and post-operatively using an electronic scale. Patients were monitored for possible bleeding episodes 24 hours, 48 hours and 72 hours after tooth extraction.
RESULTS
The values were tabulated and subjected to statistical analysis using SPSS software version 21.0 with paired t-test.
The mean blood loss showed slightly increased bleeding in Group I in comparison to Group II [Table 1]. The average bleeding time [Table 2] and mean INR [Table 3] were statistically significant among both groups. The mean clotting time [Table 4] and mean platelet count [Table 5] were not statistically significant among groups.
Table 1.
Comparison of mean, standard deviation and range of blood loss between two groups
| Groups | Mean±SD | Range |
|---|---|---|
| Group I | 4.24±3.21 | 2.01-6.42 |
| Group II | 1.07±1.11 | 1.03-2.12 |
Table 2.
Mean and range of bleeding time in seconds for two groups
| Groups | Mean±SD (in sec) | Range |
|---|---|---|
| Group I | 128.4±14.34 | 103-152 |
| Group II | 108.3±16.09 | 82-143 |
Table 3.
Mean, standard deviation and range of INR for two groups
| Groups | Mean | SD | Range |
|---|---|---|---|
| Group I | 1.14 | 0.18 | (1.00, 1.24) |
| Group II | 1.04 | 0.08 | (1.00, 1.22) |
Table 4.
Mean, standard deviation and range of clotting time in seconds for two groups
| Groups | Mean±SD (in sec) | Range |
|---|---|---|
| Group I | 328.1±46.76 | 243-630 |
| Group II | 334.0±58.68 | 240-482 |
Table 5.
Mean, standard deviation and range of platelet count for two groups
| Group | Mean | SD | Range |
|---|---|---|---|
| Group I | 2,84100 | 68343.23 | (104200-420000) |
| Group II | 2,87200 | 58554.67 | (110000-380000) |
DISCUSSION
The possibility of excessive bleeding after tooth extraction is a major apprehension in the management of patients taking antiplatelet medications.[4] Aspirin continues to be the most researched, widely used, clinically effective and least expensive antiplatelet agent currently available.
In our study, none of the patients in either group needed any additional measures to control bleeding, and no untoward bleeding was noticed post-operatively in both groups.
The bleeding times of patients who stopped taking aspirin 5–7 days before surgery and those who continued taking aspirin throughout the procedure were compared by Ardekian et al.[2] in their study. The difference in bleeding times was statistically significant (P = 0.04), but both groups of patients fell within the normal bleeding range.
Balasubramanian Krishnan’s recommended 5-day drug withdrawal appears to be incorrect.[5] Bleeding time is used to evaluate platelet function. The platelet function analyzer is the best screening test for the effect of aspirin on coagulation.[4]
Brennan et al.[3] found no significant differences in bleeding time between the two groups. Patients with INRs of 3.0 or less may not require a change in their anticoagulation regimen.[6] The likelihood of bleeding complications during tooth extraction with low-dose aspirin is very low.[7] According to Jahan et al.,[8] patients who require tooth extraction do not need to stop taking aspirin.
According to the findings of this study, low-dose aspirin therapy need not be discontinued prior to extraction procedures. To stop bleeding, local haemostasis is sufficient.
CONCLUSION
This study concludes that the long-term use of low dose aspirin appears to rarely cause any clinically significant bleeding problems in extraction procedures.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Madan GA, Madan SG, Madan G, Madan AD. Minor oral surgery without stopping daily low-dose aspirin therapy: A study of 51 patients. J Oral Maxillofac Surg. 2005;63:1262–5. doi: 10.1016/j.joms.2005.05.164. [DOI] [PubMed] [Google Scholar]
- 2.Ardekian L, Gaspar R, Peled M, Brener B, Laufer D. Does low dose aspirin therapy complicate oral surgical procedures? J Am Dent Assoc. 2000;131:331–5. doi: 10.14219/jada.archive.2000.0176. [DOI] [PubMed] [Google Scholar]
- 3.Brennan MT, Vaerin MA, Noll JL, Napenas JJ, Kent ML. Aspirin use and post-operative bleeding from dental extractions. J Dent Res. 2008;87:740–4. doi: 10.1177/154405910808700814. [DOI] [PubMed] [Google Scholar]
- 4.Little JW, Miller CS, Henry RG, McIntosh BA. Anthrombotic agents: Implications in dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93:544–51. doi: 10.1067/moe.2002.121391. [DOI] [PubMed] [Google Scholar]
- 5.Krishnan B, Shenoy NA, Alexander M. Exodontia and antiplatelet therapy. J Oral Maxillofac Surg. 2008;66:2063–6. doi: 10.1016/j.joms.2008.06.027. [DOI] [PubMed] [Google Scholar]
- 6.Campbell J, Alvarado F, Anthony Murray R. Anticoagulation and minor oral surgery: Should the anticoagulation regimen be altered. J Oral Maxillofac Surg. 2000;58:131–5. doi: 10.1016/s0278-2391(00)90324-0. [DOI] [PubMed] [Google Scholar]
- 7.Verma G. Dental extraction can be performed safely in patients on aspirin therapy: A timely reminder. ISRN Dent 2014. 2014:1–5. doi: 10.1155/2014/463684. doi: 10.1155/2014/463684. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Jahan SS, Younis M, Gul S, Ahmad Shah A, Naaz N. Aspirin intake and significant post extraction bleeding – Are they related? Int J Contemp Med Res. 2018;5:30–3. [Google Scholar]