Dental Extraction Complications in Patients on Double Antiplatelet Therapy

An interesting article titled “Hemorrhagic Complications of Dental Extractions in 181 Patients Undergoing Double Antiplatelet Therapy” written by Olga Olmos-Carrasco and et al. appears in the 2015 Journal of Oral and Maxilofacial Surgery (vol. 73, pp. 203-210). The study sought to explore if dental extractions can be done safely on patients with double antiplatelet therapy.

Double antiplatelet therapy is the combination of 100 mg per day of acetylsalicylic acid and a second antiplatelet agent. This type of therapy is done to prevent blood cells from forming a clot in certain types of patients who have a history of coronary artery disease, or have had a heart attack or stroke. A total of 181 patients with a mean age of roughly 67 were included in the study.  Most of the patients (76.8%) were male. A total of 217 teeth were extracted in the study which was conducted in Madrid.

During the course of extraction, a total of 165 patients  had light hemorrhage which lasted less than 30 minutes. In 15 patients (8.3%) the hemorrhage continued for more than 30 minutes. After 24 hours, 162 patients reported an absence of bleeding, while 15 patients (8.3%) had light hemorrhage, and 4 patients (2.2%) had a bleeding episode lasting more than 30 minutes.

Based on the results the authors feel that dental extractions can be carried out safely without stopping dual antiplatelet therapy in those patients taking it. The authors feel there were several variables in their study that may have increased the duration of bleeding in patients. This included using anesthesia without a vasoconstrictor, not using suturing, and they included patients taking NSAIDs like ibuprofen. The authors feel there were several variables in their study which may have decreased the duration of bleeding in patients. This included giving patients gauze impregnated with tranexamic acid, there was a low percentage of complex extractions (6.6%), and the number of teeth extracted was rather low (mean 1.2).

The authors feel that there results are generalizable as this study was conducted in oral and dental care consultations within primary care by 11 different dentists and they included patients that other prior studies may have excluded. The authors did not assess antiplatelet combinations other than the combination of acetylsalicylic acid and clopidogrel as they are the most common in their region. As such the authors feel that additional studies are needed to assess the frequency of hemmorrhagic complications in dental extractions in patients treated with antiplatelet combinations other than acetylsalicylic acid and clopidogrel.

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