Aspirin Use and Post-Operative Bleeding From Dental

Howard E. Strassler, DMD

Brennan MT, Valerin MA, Noll JL, et al. J Dent Res. 2008;87:740-744.

Abstract

Aspirin is a common, chronically administered preventive treatment for cardiovascular disease, but is often discontinued prior to invasive dental procedures because of concern for bleeding complications. We hypothesized that aspirin does not cause increased bleeding following a single tooth extraction. Thirty-six healthy persons requiring a tooth extraction were randomized to receive 325 mg/day aspirin or placebo for 4 days. Cutaneous bleeding time (BT) and platelet aggregation tests were obtained prior to extraction. The primary outcome measure, oral BT, and secondary bleeding outcomes were evaluated during and following extraction. No significant baseline differences, except for diastolic blood pressure, were found between groups. There were no differences in oral BT, cutaneous BT, secondary outcome measures, or compliance. Whole-blood aggregation results were significantly different between the aspirin and placebo groups. These findings suggest that there is no indication to discontinue aspirin for persons requiring single-tooth extraction.

COMMENTARY

Many of our patients are taking a low dose of aspirin as a preventive treatment for cardiovascular disease. The fear of uncontrolled bleeding often prompts physicians to have patients stop taking aspirin for 7 to 10 days before any surgical procedure. What about discontinuing aspirin before routine dental extractions? Two studies found that aspirin use does not need to be discontinued before routine dental extractions.^1,2 The results of the Ardekian study demonstrated that mean bleeding time was 1.8 +/- 0.47 minutes for patients who stopped aspirin therapy 1 week before the procedure. For patients who continued aspirin therapy, bleeding time was 3.1 +/- 0.65 minutes. The difference was statistically significant (P = .004). However, both groups were within the normal bleeding time range, and in both groups, a local hemostatic method was sufficient to control bleeding. The Madan study did not see any problems except with one patient. Both of these studies concluded that aspirin therapy should be continued throughout oral surgical procedures. Local measures are sufficient to control any bleeding during surgery.

What differentiates the study abstracted here from the two studies mentioned above is that the patients were healthy and not on aspirin prophylaxis. There were slight differences in one study that may relate to the length of time patients had been taking aspirin. There were no differences between groups for bleeding time although whole-blood aggregation results were different between both groups. Long- term use of aspirin is not a contraindication to routine extractions and patients do not need to be taken off this medication before routine dental extractions. Of note, a patient needs to be aware that there may be increased bleeding after extraction that requires a different regimen to control bleeding if they are taking aspirin.

References

1. Ardekian L, Garpar R, Peled M, et al. Does low-dose aspirin therapy complicate oral surgical procedures? J Am Dent Assoc. 2000; 131: 331-335.

2. 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; 63:1262-1265.

About the Author

Howard E. Strassler, DMD Professor and Director of Operative Dentistry Department of Endodontics, Prosthodontics and Operative Dentistry University of Maryland Dental School, Baltimore, Maryland