Effect Of Uninterrupted Antiplatelet Therapy On Postextraction Bleeding Following Single Dental Extraction: An Original Research

Abstract

Background: Cardiovascular diseases is considered to be the most common cause of death in the Western world and its treatment frequently requires therapy with antiplatelet agents, which increases the haemorrhage risk after oral surgical procedures. There exists a controversy between the continuation of the antiplatelet agents for the fear of cardiac events and the stoppage of the medications for the fear of post operative bleeding. The aim of this study is to evaluate the post extraction bleeding after single dental extraction, among patients on uninterrupted single or dual antiplatelet therapy and compare with healthy controls.

Objectives: To assess and compare the immediate (30 minutes after extraction) and late (60 minutes) post extraction bleeding following single dental extraction among healthy patients and patients on uninterrupted aspirin(75mg)/ clopidogrel(75mg)/ aspirin(75mg) + clopidogrel(75mg).

Methods: A total of n=100 study subjects were considered for study of which 50 patients on uninterrupted antiplatelet therapy, either aspirin or clopidogrel or both, requiring dental extraction were considered to be as the case group and 50 healthy patients requiring dental extraction were grouped as the control group. Extraction of the indicated tooth was done in both case and control group by the same operator. All the patients were observed for bleeding after 30 minutes and 60 minutes post extraction.

Results: In the case group, majority of the patients were in the age group of 61-70years (56%) and 51-60 years (38%) in the control group. The prevalence of anti platelet therapy usage was more among the males in comparison to females. Majority of the patients reported for extraction of tooth due to unrestorable caries in both the groups (76% in case and 74% in control group), followed by extraction due to periodontal problems. 66% of the patients were under single antiplatelet therapy with aspirin, followed by 24% of patients under dual antiplatelet therapy with aspirin and clopidogrel and 10% under single antiplatelet therapy with clopidogrel. The main reason for antiplatelet therapy was found to be coronary artery disease (90%), followed by CVA (6%) and PAD (4%). Only 4% of patients in the case group had bleeding 30minutes post extraction, which was managed by local haemostatic measure, and there was no bleeding noted 60 minutes post extraction in both case and control group.

Interpretation and conclusion: Interruption of antiplatelet therapy prior to single dental extraction is not necessary, and there is no hemorrhagic risk associated with it. Local haemostatic measures are sufficient to control bleeding.