Assessment of the risk of haemorrhage and its control following minor oral surgical procedures in patients on anti-platelet therapy: a prospective study.
Controversy exists concerning the suspension or maintenance of anti-platelet drugs before elective surgical procedures. We assessed the association of the risk of prolonged postoperative bleeding with anti-platelet therapy by type of minor surgical procedure and the association between anti-platelet therapy and the level of hemostatic measures required. Five hundred and forty-six patients were included in the study group: those on aspirin (n = 310), clopidogrel (n = 97), and aspirin + clopidogrel dual therapy (n = 139); the control group comprised 575 healthy individuals. Cramer's V test was significant (P < 0.05) but showed a weak association between anti-platelet therapy and prolonged immediate postoperative bleeding. Compared to controls, the odds ratio revealed that the risk of prolonged bleeding in the immediate postoperative period was significantly higher with dual therapy, followed by clopidogrel and aspirin. Prolonged bleeding occurred in 22 patients in the study group and 20 in the control group, and was successfully controlled with local hemostatic measures. Fisher's exact test showed a significant association between dual therapy and higher levels of hemostatic measures (P = 0.004; P = 0.035). Prolonged bleeding in patients on anti-platelet therapy was independent of the type of minor surgical procedure. The greatest risk of prolonged bleeding was found in patients on dual therapy; this required higher levels of hemostatic measures.
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India. Electronic address: charugirotra@yahoo.com.
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Girotra
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India.
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Padhye
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India.
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Mandlik
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India.
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Dabir
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India.
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Gite
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India.
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Dhonnar
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India.
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Pandhi
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India.
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Vandekar
D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D000077144:Clopidogrel; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
anti-platelet therapy; local hemostatic measures; minor oral surgery; risk of prolonged postoperative bleeding