Objective
We conducted a review of the literature to assess risk for oral bleeding complications
after dental procedures in patients on antiplatelet therapy.
Study Design
We conducted a search in Medline, Embase, and National Guideline Clearinghouse databases
for studies involving patients on single and dual antiplatelet therapy that had invasive
dental procedures or manipulations that induce oral bleeding.
Results
The literature search yielded 15 studies that met inclusion criteria. There is a trend
toward increased occurrence of immediate postoperative bleeding for dual antiplatelet
therapy, but there is no increase in the occurrence of intra- or late postoperative
bleeding complications.
Conclusions
We found no clinically significant increased risk of postoperative bleeding complications
from invasive dental procedures in patients on either single or dual antiplatelet
therapy. These findings support the recommendation that there is no indication to
alter or stop these drugs, and that local hemostatic measures are sufficient to control
bleeding.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The clinical importance of acquired abnormalities of platelet function.N Engl J Med. 1991; 324: 27-39
- Regulatory functions of the vascular endothelium.N Engl J Med. 1990; 323: 27-36
- A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE).Lancet. 1996; 348: 1329-1339
- Increased tendency toward gingival bleeding caused by joint effect of alpha-tocopherol supplementation and acetylsalicylic acid.Ann Med. 1998; 30: 542-546
- Dental management considerations for the patient with an acquired coagulopathy.Br Dent J. 2003; 195: 495-501
- Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society For Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians.J Am Dent Assoc. 2007; 138: 652-655
- Exodontia and antiplatelet therapy.J Oral Maxillofac Surg. 2008; 66: 2063-2066
- The effect of platelet-altering medications on bleeding from minor oral surgery procedures.J Oral Maxillofac Surg. 2008; 66: 93-97
- Dental extractions in patients on antiplatelet therapy.Med Oral Patol Oral Cir Bucal. 2009; 14: e588-e592
- The effect of aspirin intake on bleeding on probing in patients with gingivitis.J Periodontol. 2004; 75: 679-684
- The effect of aspirin on the periodontal parameter bleeding on probing.J Periodontol. 2002; 73: 871-876
- Safety of dental extractions in coronary drug-eluting stenting patients without stopping multiple antiplatelet agents.Clin Cardiol. 2012; 35: 225-230
- Does low-dose aspirin therapy complicate oral surgical procedures?.J Am Dent Assoc. 2000; 131: 331-335
- Aspirin use and post-operative bleeding from dental extractions.J Dent Res. 2008; 87: 740-744
- Minor oral surgery without stopping daily low-dose aspirin therapy: a study of 51 patients.J Oral Maxillofac Surg. 2005; 63: 1262-1265
- Safety of dental extractions during uninterrupted single or dual antiplatelet treatment.Am J Cardiol. 2011; 108: 964-967
- Evaluation of bleeding risk and measurement methods in dental patients.Med Oral Patol Oral Cir Bucal. 2010; 15: e863-e868
- The frequency of bleeding complications after invasive dental treatment in patients receiving single and dual antiplatelet therapy.J Am Dent Assoc. 2009; 140: 690-695
- Risk factors affecting postoperative hemorrhage after tooth extraction in patients receiving oral antithrombotic therapy.J Oral Maxillofac Surg. 2011; 69: 1550-1556
- Hemostatic management for periodontal treatments in patients on oral antithrombotic therapy: a retrospective study.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 889-896
- Myocardial infarction after aspirin cessation in stable coronary artery disease patients.Int J Cardiol. 2000; 76: 257-258
- Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis.J Am Coll Cardiol. 2005; 45: 456-459
- Catastrophic outcomes of noncardiac surgery soon after coronary stenting.J Am Coll Cardiol. 2000; 35: 1288-1294
- Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry.Circulation. 2006; 113: 2803-2809
- Prevalence, predictors, and long-term prognosis of premature discontinuation of oral antiplatelet therapy after drug eluting stent implantation.Am J Cardiol. 2011; 107: 186-194
- Management of dental patients taking common hemostasis-altering medications.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: S45-S49
- Relationship between bleeding time test and postextraction bleeding in a healthy control population.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 94: 439-443
Article info
Publication history
Published online: January 17, 2013
Accepted:
October 22,
2012
Received in revised form:
September 29,
2012
Received:
August 1,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
