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Risk of Postoperative Bleeding After Dental Extraction in Patients on Antiplatelet Therapy
TAKE-HOME MESSAGE
- This systematic review and meta-analysis evaluated the risk of postoperative bleeding after dental extraction in patients on antiplatelet therapy (APT). Following a minor dental extraction, no significant association was observed between the risk of immediate and delayed bleeding in those on aspirin therapy compared with healthy controls. A significantly increased risk of immediate bleeding was observed in patients on single nonaspirin APT. The relative risk of immediate bleeding in those treated with dual APT was considerably higher than that in healthy controls and remained significantly higher when assessing delayed bleeding.
- Pre-extraction interruption of dual APT is unpredictable in minimizing the bleeding risk and might expose the patient to complications and thrombotic events. Clinicians need to take careful precautions and consult with the patient's physician prior to the procedure to find an alternative solution for hemostasis after extraction in patients on dual APT.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
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.
Additional Info
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 Mar 01;137(3)224-242, J AlAgil, Z AlDaamah, A Khan, O OmarFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.