When I Can I Take Asperin Again After Having Teeth Extracted

Saudi Dent J. 2009 Jul; 21(2): 57–61.

The effect of aspirin on bleeding after extraction of teeth

Received 2009 Jan 3; Revised 2009 Feb i; Accepted 2009 February 11.

Abstruse

Acetylsalicylic acid (ASA) generically known as aspirin is used clinically equally an analgesic, antipyretic, anti-inflammatory and equally a medication to prevent platelet assemblage. Many studies have investigated bleeding associated with ASA.

Objective

The aim of this written report was to determine if ASA was associated with bleeding afterwards dental extraction.

Patients and methods

One hundred and eighty-nine subjects were divided into iv groups. Group 1A subjects who received ASA, underwent simple extraction. Group 1B subjects who received ASA, underwent surgical extraction. Group 2A subjects who did non receive ASA, underwent simple extraction which served every bit control group. Group 2B subjects who did non receive ASA, underwent surgical extraction which also served equally control group.

Results

The results showed that Group 1B was the only group which showed haemorrhage after 24 h. All groups had similar results after 48 h and v days postal service-operatively.

Determination

The study concluded that subjects who received 81 mg ASA daily could undergo dental extraction without haemorrhage risks.

one. Introduction

Acetylsalicylic acid (ASA) generically known as aspirin is used clinically equally an analgesic, antipyretic, anti-inflammatory agents and as a medication to prevent platelet aggregation. It is indicated for long term use in patients susceptible to the formation of emboli, such as patients who take suffered from stroke, angina or myocardial infarctions (Anonymous, 2002).

In 1899, a French pharmacist, Charles Frederic Gerhardt was the first to isolate and prepare aspirin. The name aspirin was derived from A "Acetyl" and Spirin from "Spirsäure", an one-time German language name for salicylic acid.

ASA suppresses the production of prostaglandin (PG) and thromboxane (Thx) by the inactivation of cyclooxygenase enzyme. In addition, information technology blocks Thx A₂ leading to a defect in platelet aggregation. The role in platelets leads to the reduction of the incidence of embolism (Brennan et al., 2007). The Antiplatelets Trialists' Collaboration in a meta analysis of 135,000 patients in around 300 studies has shown the condom effect of ASA on patients who have suffered from myocardial infarction, angina or stroke, and that the vascular events were reduced past 20–25% and mortality reduced by 12% (Antiplatelets Trialists' Collaboration, 1994).

The upshot of aspirin on platelets is measured by bleeding fourth dimension. Many studies have shown that a low dose of ASA has an consequence on bleeding time (Yokoyama et al., 2008; Marshall et al., 1997). All the same, others have shown that there were no effects on bleeding subsequently extraction of teeth (Krishnan et al., 2008). investigated dental extraction in three groups, Group i patients stopped the use of aspirin earlier dental extraction, Group 2 continued aspirin during the dental extraction and Group 3 did non use aspirin. They institute that no significant differences in haemorrhage time were evident among all iii groups and they recommended that patients should go on taking ASA during dental extraction (Krishnan et al., 2008). Discontinuing the use of ASA before dental extraction was too investigated by Aframian et al. (2007) and they recommended that the utilize of ASA did non have to exist discontinued before dental extraction.

The aim of this study was to make up one's mind if ASA was associated with bleeding after tooth extraction.

two. Patients and methods

A total of 189 subjects (54 males and 135 females) were included in this study. The subjects are divided into 2 groups: Grouping ane comprised 102 subjects (29 males and 73 females) who were using ASA 81 mg one time a mean solar day for the previous six months. Group 2 was the command group and it comprised 87 subjects (25 males and 62 females) who did not use ASA. The age of the subjects ranged from 45 to 65 years (hateful 58 years).

The exclusion criteria included subjects with anaemia, liver disease or whatever medical condition which might touch the coagulation procedure and subjects with a history of bleeding episodes or epistaxis. In add-on, subjects suffering from any psychiatric diseases were not included in the report. Subjects with a systolic blood pressure in a higher place 150 mm/gh or a diastolic blood pressure level higher up 98 mm/gh were excluded.

The extractions were divided in two categories. Category A subjects who underwent unproblematic extraction and Category B subjects who underwent surgical extraction. All extracted teeth in this study were maxillary or mandibular molars.

Group 1A: Subjects who received ASA and underwent unproblematic extraction (17 males and 36 females).
Grouping 1B: Field of study who received ASA and underwent surgical extraction (12 males and 37 females).
Group 2A: Control subjects who underwent elementary extraction (11 males and 30 females).
Group 2B: Control subjects who underwent surgical extraction (fourteen males and 32 females).

three. Surgical procedures

The blood pressure of each of all the subjects was recorded preoperatively. The simple extraction cases underwent local amazement using 2% lidocaine 2% with 1:100,000 epinephrine. The tooth was subluxated and extracted by the appropriate instruments. The surgical extraction was besides performed under local anaesthesia using 2% lidocaine with one:100,000 epinephrine in which a flap was raised and the tooth was surgically extracted. A figure of eight suture was practical. The subjects were then asked to utilise pressure level on a piece of sterile gauze for 30 min and were so re-evaluated for bleeding. If the subjects did not have any signs of bleeding at that time, they were discharged and contacted past phone 12 h, 24 h, 48 h and v days post-operatively. If there was whatever bleeding, they were re-examined, new gauze was placed and re-evaluated subsequently xxx min.

Any agile oozing from the socket after 30 min was considered firsthand bleeding. If the subjects reported during the phone communication that at that place was bleeding, they were instructed to return for further evaluation. Antibiotics were not prescribed for any of the subjects and the only hurting medication used was paracetamol 500 mg one tablet every 6 h in all subjects. Nevertheless, the ASA groups were instructed to continue their medications. Subjects who took any other pain medication were excluded from the study.

4. Results

In Group 1A, out of the 53 subjects, only two (3.8%) subjects had oozing of blood after thirty min of extraction. One female person indicated that she withal had oozing of blood 12 h post-operatively. The patient was seen, re-evaluated and asked only to apply pressure level over the gauze which controlled the bleeding. She was contacted 24 h and 48 h post-operatively and she indicated no farther haemorrhage. None of this group required any medical attention and only one subject came for re-evaluation after 12 h. None of them complained later on 24 h or 48 h post-operatively.

In Group 1B, out of the 49 subjects who underwent surgical procedures to remove a tooth, only three (6.1%) subjects had oozing of blood subsequently 30 min on the surgical site. However, after 12 h, only i subject complained of oozing of blood. The patient was seen and was well after applying force per unit area. One male complained of bleeding after 24 h. He was seen and later on applying pressure, the oozing stopped. Subsequently 48 h, none of the subjects in Group 1B had any bleedings.

In Grouping 2A, only i subject presented with pocket-size oozing after xxx min. After 12 h still, none of the subjects had whatsoever complaints. In Group 2B, i discipline presented with oozing after 30 min and the same field of study was seen after 12 h with mild oozing controlled later applying pressure level to the site. All subjects in Groups 2A and 2B indicated no bleeding after 24 h and 48 h postal service-operatively. None of the subjects showed delayed bleeding later on 5 days. A summary of these findings is shown in Table 1.

Tabular array 1

Post-extraction bleeding in the report and command groups.

Group	Number of subjects	30 min later extraction	12 h postal service-operative	24 h post-operative
1A	53	2	1	0
1B	49	3	i	one
2A	41	1	0	0
2B	46	i	1	0

5. Discussion

ASA is recommended in many cases as a prevention of emboli formation and as an analgesic. Dental clinicians are frequently faced with the question of whether or non ASA should exist stopped or connected before extraction. Madan et al. (2005) investigated bleeding in 51 patients taking aspirin who underwent extraction of teeth. Merely one patient had bleeding which was controlled by local measures. The authors recommended continuing ASA during dental extraction (Madan et al., 2005). Garnier et al. (2007) did extraction of 218 teeth and merely three extraction sites had prolonged bleeding.

Hemelik et al. (2006) performed extraction in two groups: Group 1 patients on 100 mg ASA daily and Group ii did not take any medication which served every bit a command group. The findings indicated that haemorrhage occurred in ane.54% in the ASA grouping and i.59% in the command grouping, respectively. In the present written report, bleeding occurred in nigh 2% of patients in both the command and study groups post-obit surgical extractions after 12 h. Nevertheless, later on 48 h both groups demonstrated no bleeding. Morimoto et al. (2008) performed extraction on 87 patients who had taken antiplatelets and plant that the bleeding occurred in two.ii%. The findings of the present report are in agreement with those of Morimoto.

Brennan et al. (2008) studied 36 patients divided into two groups: Group 1 patients received 325 mg ASA daily and Group 2 served every bit control. They investigated the bleeding time. No significant differences were institute between the two groups in the haemorrhage fourth dimension. They recommended not stopping ASA before the surgical procedure.

Some authors indicated that patients responded differently to the medication they were using. Some patients were hyper responders and may have prolonged bleeding. Sonksen et al. (1999) studied bleeding time in subjects taking ASA. Group 1 included 17 patients taking 75 mg, Group 2 included 16 patients who were taking 300 mg, Group 3 served as a control group. Meaning differences in haemorrhage time were plant between the ASA users and the control grouping. In improver, some cases in Group 1 (3 patients) and in Group two (v patients) showed loftier haemorrhage fourth dimension and they were considered hyper responders (Sonksen et al., 1999).

Ardekian et al. (2000) studied bleeding time in two groups: 1 used ASA and one served as control. The bleeding time was i.8/0.47 min in the control grouping and in the ASA group, it was 3.1/0.65 min. They had four patients from ASA grouping and two patients from the command group who had prolonged bleeding after extraction. They had to apply ten% tranexamic acid and antifibriolytic agent to stabilize the clots (Ardekian et al., 2000). This miracle of hyper response to ASA may explicate why some patients may have more oozing of blood compared to others, even if they are taking the same doses.

Bartlett (1999) investigated minor and pregnant complications later cutaneous minor surgery. The study was designed to have two groups. Group one with 52 patients who continued ASA whereas 119 patients served as a control grouping. The results indicated that 1.ix% demonstrated minor complication in ASA users versus 3.iii% in the control group. However, the significant complexity was three.viii% in ASA user and iv.2 in the control group (Bartlett, 1999). The finding indicated that ASA use did non cause mail service-surgical complications similar to the findings of the present study. Shalom and Wang (2000) found no difference in the bleeding pattern betwixt patients who had taken ASA and the control grouping during excision of a cutaneous lesions.

The outcome of pregnant blood loss during small oral surgery was examined by Patridge et al. (2008) who concluded that patients who had taken ASA demonstrated blood loss one.97 g per unit of surgery compared to 1.96 g per unit of surgery in the command group. Therefore, no significant statistical difference between the two groups was found. This finding supported the notion that ASA should not be stopped before minor oral surgery.

The issue of continuing ASA during major surgery has besides been investigated. Dhiwakar et al. (2006) performed major surgical procedure in patients who had taken ASA and they recommend stopping ASA. Opposite to that, Anekstein et al. (2004) concluded it is safe to do femoral fracture repair if the patient had taken ASA. Even so, they required 0.5 L more of blood. Korinth et al. (2007) did a survey request neurosurgeon nearly patients taking ASA in cases of spinal surgery and found eighty% of the neurosurgeons had a policy to discontinue ASA preoperatively. Potoski and Amenabar (2007) and many others recommended non stopping ASA for minor oral surgery as what we recommend.

6. Determination

ASA is a widely used medication and information technology functions as analgesic and antiplatelets. This study demonstrated that extraction of teeth in patients taking 81 mg of ASA did not cause significant bleeding post-operatively. All mail-operative haemorrhage was controlled by using good local measures. For minor oral surgery procedures, nosotros practice non recommend that patients using ASA should terminate taking the medication.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722997/