1
|
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 Surg Oral Med Oral Pathol Oral Radiol 2024; 137:224-242. [PMID: 38155005 DOI: 10.1016/j.oooo.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To determine the risk of bleeding after minor extraction in patients on different antiplatelet therapy (APT) regimens. STUDY DESIGN A search was conducted using PubMed and Google Scholar. Thirty-five papers were included in the systematic review, of which 23 papers provided the requisite information for meta-analysis. Subgroups were created based on the controls, as follows: (1) no control, (2) healthy control, and (3) interrupted APT control. In a meta-analysis, the studies were further subdivided into immediate and delayed bleeding. RESULTS No immediate or delayed bleeding risk was found in patients treated with aspirin vs healthy controls (relative risk [RR] = 1.26; P = .5 and RR = 2.17; P = .09, respectively). A higher immediate bleeding was recorded for patients on single nonaspirin APT vs those in the healthy population (RR = 3.72; P = .0009). A high risk of bleeding was recorded in patients receiving dual APT compared with healthy controls for immediate (RR = 10.3; P < .0001) and delayed (RR = 7.72; P = .001) bleeding. Dual APT continuation showed a higher risk of immediate bleeding (RR = 2.13) than interrupted APT, but the difference was insignificant (P = .07). CONCLUSIONS Dental extraction can be performed safely in patients on aspirin monotherapy. In contrast, patients receiving dual APT should be considered at risk for immediate and continued bleeding.
Collapse
Affiliation(s)
- Jumana AlAgil
- Fellowship in Periodontics Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ziyad AlDaamah
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Assad Khan
- King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
| | - Omar Omar
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| |
Collapse
|
2
|
Muacevic A, Adler JR, Kalidoss VK, Polineni S, Jayam C, Kumar C. The Optimal Hemostasis Duration After Tooth Extraction: A Randomized Controlled Trial. Cureus 2023; 15:e33331. [PMID: 36741661 PMCID: PMC9895223 DOI: 10.7759/cureus.33331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
Background There is a lack of evidence-based practice regarding the duration of pressure pack placement following tooth extraction. This study aimed to compare the incidence of post-extraction bleeding following 60 minutes versus 10 minutes of pressure pack placement. Methodology A randomized controlled trial was conducted at a tertiary care hospital and included patients requiring intra-alveolar tooth extractions. Patients were randomly allocated into the experimental group or control group by a permuted block randomization method. A blinded observer noted the incidence of post-extraction bleeding. Categorical variables were summarized as frequency and percentage. The chi-square test was used for intergroup statistical analysis. P-values <0.05 were considered statistically significant. Results There were 528 participants, 264 of whom were allocated to each group. The incidence of post-extraction bleeding was 8% and 6.8% in the experimental and control groups, respectively. On bivariate analysis, there was no statistically significant difference between the two groups (p = 0.618; relative risk with 95% confidence interval = 1.0). Conclusions In the majority of cases, hemostasis was achieved in 10 minutes. Therefore, removing the pressure pack after 10 minutes may be advised to ensure hemostasis and, ultimately, save chairside time.
Collapse
|
3
|
ÇETİN ÖZDEMİR E, UZUNKAYA M. Evaluation of the Awareness of Physicians and Dentists for the Relationship Between Periodontal Status and Systemic Diseases. CUMHURIYET DENTAL JOURNAL 2022. [DOI: 10.7126/cumudj.1009537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eda ÇETİN ÖZDEMİR
- KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, KAHRAMANMARAŞ SAĞLIK YÜKSEKOKULU
| | | |
Collapse
|
4
|
Yerragudi N, Chawla J, Kalidoss VK, Polineni S, Jayam C. Evaluation of time required to achieve haemostasis following dental extraction: A randomized controlled clinical trial. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
5
|
Al Sharrad A, Said KN, Farook FF, Shafik S, Al-Shammari K. Awareness of the Relationship between Systemic and Periodontal Diseases among Physicians and Dentists in Saudi Arabia and Kuwait: Cross-sectional Study. Open Dent J 2019. [DOI: 10.2174/1874210601913010288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background:Previous studies have shown possible association between periodontal diseases and Diabetes Mellitus (DM), Cardiovascular Disease (CVD) and Adverse Pregnancy Outcomes (APO). Increasing the knowledge of physicians and dentists regarding the association between periodontal disease and systemic diseases should improve their ability to provide a high standard of treatment for the disease and prevent its consequences. In our study, we sought to identify knowledge gaps in the awareness of the relationship between systemic and periodontal diseases among dentists and physicians from the Kingdom of Saudi Arabia and the State of Kuwait.Methods:A cross-sectional study was performed with a convenient sample of selected physicians and dentists in Saudi Arabia and Kuwait using a self-developed structured questionnaire. Physicians’ and dentists’ awareness were assessed regarding current evidence of the relationship between systemic diseases and conditions (DM, CVD, APO) and periodontal diseases.Results:A total of 134 (21.5%) of the identified physicians and 485 (78%) of the identified dentists participated in this study. More than half of the participants (52.1% physicians and 67.5% dentists) agreed that there is a relationship between periodontal diseases and DM, CVD and APO. Dentists had a statistically higher level of awareness compared with the physicians. The findings related to the awareness of the dentist sub groups highlighted that periodontists were significantly more likely to have a good level of knowledge.Conclusion:Within the limitations of this study, we concluded that the awareness of physicians and dentists regarding the relationship between periodontal diseases and systemic diseases (DM, CVD, APO) is generally low, Therefore, improved collaboration between medical and dental health providers is recommended.
Collapse
|
6
|
Rojanaworarit C, Limsawan S. Risk of Hemorrhage Attributed to Underlying Chronic Diseases and Uninterrupted Aspirin Therapy of Patients Undergoing Minor Oral Surgical Procedures: A Retrospective Cohort Study. J Prev Med Public Health 2017; 50:165-176. [PMID: 28605890 PMCID: PMC5495684 DOI: 10.3961/jpmph.16.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 03/31/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives This study aimed to estimate the risk of bleeding following minor oral surgical procedures and uninterrupted aspirin therapy in high-risk patients or patients with existing chronic diseases compared to patients who did not use aspirin during minor oral surgery at a public hospital. Methods This retrospective cohort study analyzed the data of 2912 patients, aged 20 years or older, who underwent 5251 minor oral surgical procedures at a district hospital in Thailand. The aspirin group was comprised of patients continuing aspirin therapy during oral surgery. The non-aspirin group (reference) included all those who did not use aspirin during surgery. Immediate and late-onset bleeding was evaluated in each procedure. The risk ratio of bleeding was estimated using a multilevel Poisson regression. Results The overall cumulative incidence of immediate bleeding was 1.3% of total procedures. No late-onset bleeding was found. A significantly greater incidence of bleeding was found in the aspirin group (5.8% of procedures, p<0.001). After adjusting for covariates, a multilevel Poisson regression model estimated that the bleeding risk in the aspirin group was 4.5 times higher than that of the non-aspirin group (95% confidence interval, 2.0 to 10.0; p<0.001). However, all bleeding events were controlled by simple hemostatic measures. Conclusions High-risk patients or patients with existing chronic diseases who continued aspirin therapy following minor oral surgery were at a higher risk of hemorrhage than general patients who had not used aspirin. Nonetheless, bleeding complications were not life-threatening and could be promptly managed by simple hemostatic measures. The procedures could therefore be provided with an awareness of increased bleeding risk, prepared hemostatic measures, and postoperative monitoring, without the need for discontinuing aspirin, which could lead to more serious complications.
Collapse
Affiliation(s)
| | - Soontaree Limsawan
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| |
Collapse
|
7
|
Abstract
BACKGROUND Haemostasis is crucial for the success of oral surgical treatment as bleeding problems can cause complications both pre- and post-operatively. Patients on antiplatelet drugs present a challenge due to their increased risk of bleeding. AIMS To identify a protocol for the management of oral surgery patients on dual antiplatelet therapy (aspirin and clopidogrel). METHODS A literature review was conducted in January 2016 of free-text and MESH searches (keywords: aspirin, clopidogrel and dental extractions) in the Cochrane Library, PubMed and CINAHL. Trial registers, professional bodies for guidelines and OpenGrey for unpublished literature were also searched. Studies were selected for appraisal after limits were applied (adult, human and English only studies) and inclusion/exclusion criteria imposed. RESULTS Eight studies were identified for critical appraisal using the CASP tools. These were a combination of retrospective, prospective, cohort and case control studies. Napenas et al. and Park et al. found no statistically significant risk of postoperative bleeding complications in patients on dual antiplatelet therapy. Girotra et al., Lillis et al., Omar et al. and Olmos-Carrasco et al., however, found statistically significant risk of postoperative bleeding in this group of patients, all of which can be controlled with local measures. CONCLUSION Patients on dual antiplatelet therapy - although at an increased risk of postoperative bleeding complications - can be managed safely with local haemostatic measures and without the need to discontinue antiplatelet therapy.
Collapse
|
8
|
Jané-Pallí E, Arranz-Obispo C, González-Navarro B, Murat J, Ayuso-Montero R, Rojas S, Santamaría A, Jané-Salas E, López-López J. Analytical parameters and vital signs in patients subjected to dental extraction. J Clin Exp Dent 2017; 9:e223-e230. [PMID: 28210440 PMCID: PMC5303322 DOI: 10.4317/jced.53474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 09/28/2016] [Indexed: 01/18/2023] Open
Abstract
Background Dental consultation may provoke stress to the patient, especially when a dental surgery is going to be performed, stressful situations can cause a reaction in the sympathetic nervous system that could lead to cardiovascular alterations. Blood pressure and cardiac frequency are used often as an indirect measurement and this parameters combined can serve as good indicators of stress. Objective: Analyze the changes in vital signs and analytical parameters induced by a dental extraction. Material and Methods 24 healthy patients who required a simple dental extraction underwent to a blood test and motorization of their pre- and post-extraction vital signs before, at 2 and 48 hours after the procedure. Data analysis was performed by means of repeated measures one way ANOVA followed by multiple comparisons Bonferroni’s Post-hoc test. Results The evaluated patients were 13 women and 11 men with an average age of 35.1. Thirteen patients (54.17% of the sample) were smokers and five were regular drinkers (20.8%). No significant differences were observed in the vital signs with the exception of diastolic blood pressure and cardiac rate that were slightly lower after extraction. Only two analytical parameters showed statistical significant changes. Total bilirubin was significantly higher at 48 hours after extraction and leukocyte count was significantly lower at this time. In any case, the magnitude of the changes observed was very low. The analytical parameters and the vital signs did not show any relevant change. Conclusions Eventual alterations found after simple tooth extraction should not be attributed to the procedure. Key words:Blood pressure, heart rate, monitoring physiologic, oxygen saturation, tooth extraction.
Collapse
Affiliation(s)
- Enric Jané-Pallí
- Departament of Odontostomatology. School of Dentistry. Barcelona University. Hospitalet de Llobregat, Spain
| | - Carlos Arranz-Obispo
- Departament of Odontostomatology. School of Dentistry. Barcelona University. Hospitalet de Llobregat, Spain
| | - Beatriz González-Navarro
- Departament of Odontostomatology. School of Dentistry. Barcelona University. Hospitalet de Llobregat, Spain
| | - Jesús Murat
- Thrombotargets Europe, S.L. Mediterranean Technological Park (Parque Mediterráneo de la Tecnología). Castelldefels, Spain
| | - Raúl Ayuso-Montero
- Departament of Odontostomatology. School of Dentistry. Barcelona University. Hospitalet de Llobregat, Spain
| | - Santiago Rojas
- Thrombotargets Europe, S.L. Mediterranean Technological Park (Parque Mediterráneo de la Tecnología). Castelldefels, Spain
| | - Amparo Santamaría
- Hemostasis and Thrombosis Unit. Department of Hematology. Hospital Universitario Vall d'Hebrón. Barcelona, Spain
| | - Enric Jané-Salas
- Departament of Odontostomatology. School of Dentistry. Barcelona University. Hospitalet de Llobregat, Spain
| | - José López-López
- Departament of Odontostomatology. School of Dentistry. Barcelona University. Hospitalet de Llobregat, Spain
| |
Collapse
|
9
|
Zhao B, Wang P, Dong Y, Zhu Y, Zhao H. Should aspirin be stopped before tooth extraction? A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:522-30. [PMID: 25767068 DOI: 10.1016/j.oooo.2015.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 11/25/2014] [Accepted: 01/14/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To carry out a standard meta-analysis to determine if aspirin should be stopped before tooth extraction. STUDY DESIGN The PubMed, ScienceDirect, EBSCOhost, and Science Citation Index databases were searched for studies published up to September 30, 2014. Eligible studies were restricted to randomized controlled trials (RCTs) and controlled, nonrandomized trials. RESULTS Three RCTs and seven controlled trials met the inclusion criteria (covering 1752 patients: 529 on aspirin therapy and 1223 not on aspirin therapy). The results showed that the risk of postoperative hemorrhage was significantly higher in patients on aspirin therapy (relative risk [RR] = 2.46; 95% confidence interval [CI]: 1.45-4.81) but that bleeding time (BT) was not significantly different between the two groups (standardized mean difference [SMD] = 0.63; 95% CI: -0.04 to 1.31). Sensitivity analyses showed that the results were unstable. CONCLUSIONS We could reach a conclusion that BT is prolonged or hemorrhage is exacerbated by long-term use of aspirin. We recommend not stopping long-term aspirin use before tooth extraction but enhancing hemostasis methods, if necessary.
Collapse
Affiliation(s)
- Bingjie Zhao
- College of Stomatology, Shandong University, Number 44, Wen Hua Xi Lu, Jinan City, Shandong Province 250012, China; Shandong Provincial Key Laboratory of Oral Biomedicine, Number 44, Wen Hua Xi Lu, Jinan City, Shandong Province 250012, China
| | - Peihuan Wang
- Department of Stomatology, Jinan Military General Hospital, Jinan City, Shandong Province 250012, China
| | - Yabing Dong
- College of Stomatology, Shandong University, Number 44, Wen Hua Xi Lu, Jinan City, Shandong Province 250012, China; Shandong Provincial Key Laboratory of Oral Biomedicine, Number 44, Wen Hua Xi Lu, Jinan City, Shandong Province 250012, China
| | - Yong Zhu
- College of Stomatology, Shandong University, Number 44, Wen Hua Xi Lu, Jinan City, Shandong Province 250012, China; Shandong Provincial Key Laboratory of Oral Biomedicine, Number 44, Wen Hua Xi Lu, Jinan City, Shandong Province 250012, China
| | - Huaqiang Zhao
- College of Stomatology, Shandong University, Number 44, Wen Hua Xi Lu, Jinan City, Shandong Province 250012, China.
| |
Collapse
|
10
|
Wahl MJ. Dental surgery and antiplatelet agents: bleed or die. Am J Med 2014; 127:260-7. [PMID: 24333202 DOI: 10.1016/j.amjmed.2013.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 11/02/2013] [Accepted: 11/13/2013] [Indexed: 01/14/2023]
Abstract
In patients taking antiplatelet medications who are undergoing dental surgery, physicians and dentists must weigh the bleeding risks in continuing antiplatelet medications versus the thrombotic risks in interrupting antiplatelet medications. Bleeding complications requiring more than local measures for hemostasis are rare after dental surgery in patients taking antiplatelet medications. Conversely, the risk for thrombotic complications after interruption of antiplatelet therapy for dental procedures apparently is significant, although small. When a clinician is faced with a decision to continue or interrupt antiplatelet therapy for a dental surgical patient, the decision comes down to "bleed or die." That is, there is a remote chance that continuing antiplatelet therapy will result in a (nonfatal) bleeding problem requiring more than local measures for hemostasis versus a small but significant chance that interrupting antiplatelet therapy will result in a (possibly fatal) thromboembolic complication. The decision is simple: It is time to stop interrupting antiplatelet therapy for dental surgery.
Collapse
|
11
|
Dental extraction can be performed safely in patients on aspirin therapy: a timely reminder. ISRN DENTISTRY 2014; 2014:463684. [PMID: 25093121 PMCID: PMC4004018 DOI: 10.1155/2014/463684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/16/2014] [Indexed: 12/01/2022]
Abstract
Cardiac patients on aspirin therapy may require extractions for their diseased teeth. It is a common practice among physicians and treating surgeons to stop aspirin prior to tooth extraction because of fear of bleeding complications. This practice often predisposes the patient to adverse thromboembolic events. This practice is based on theoretical risk of bleeding and on isolated case reports of excessive bleeding with aspirin therapy. The current consensus and recommendations are in favor of continuing aspirin therapy during simple tooth extraction as the bleeding complication incidence is very less and if it occurs can be controlled efficiently with local hemostasis measures.
Collapse
|
12
|
Abdeshahi SK, Hashemipour MA, Mesgarzadeh V, Shahidi Payam A, Halaj Monfared A. Effect of hypnosis on induction of local anaesthesia, pain perception, control of haemorrhage and anxiety during extraction of third molars: A case–control study. J Craniomaxillofac Surg 2013; 41:310-5. [DOI: 10.1016/j.jcms.2012.10.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 11/16/2022] Open
|