title: Prasugrel Versus Clopidogrel: A Comparative Examination of Local Bleeding After Dental Extraction in Patients Receiving Dual Antiplatelet Therapy.
abstract: OBJECTIVE
  To study the effects of various parameters on local hemostasis after dental extraction in patients receiving different combinations of medications who had previously confirmed effective dual inhibition of platelet aggregation.
  
  
  METHODS
  A total of 129 patients were enrolled. They underwent acute or planned percutaneous coronary intervention and their stomatological examination disclosed teeth that could have acted as foci and thus had to be removed. All patients took acetylsalicylic acid 100 mg and clopidogrel or prasugrel. Lidocaine with or without epinephrine was used for local anesthesia, and a gauze swab or suture was applied to help hemostasis.
  
  
  RESULTS
  Bleeding time was significantly longer by an average of 10 minutes (+21%) in patients taking prasugrel (P < .05) compared with those taking clopidogrel. Use of a suture resulted in a significantly shorter bleeding time after anesthesia with or without epinephrine (P < .05). A considerably longer bleeding time was observed when anesthesia with no epinephrine was combined with gauze. In smokers, the bleeding time was shorter by 15% on average.
  
  
  CONCLUSIONS
  This study is the first to analyze differences in bleeding times between clopidogrel and prasugrel treatments during dental extraction. In general, prasugrel is associated with a considerably longer bleeding time; nevertheless, dental extraction can be performed safely with either combination.
authors.affiliation: Private Practice, Villányi Dent, Budapest, Hungary.
authors.forename: Balázs Bence
authors.initials: BB
authors.lastname: Dézsi
authors.affiliation: Department Head, Department of Oral Surgery, Petz Aladár County Teaching Hospital, Győr, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Koritsánszky
authors.affiliation: Senior Lecturer, Department of Oral Surgery, Faculty of Dentistry, University of Szeged, Szeged, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Braunitzer
authors.affiliation: Assistant Lecturer, Department of Periodontology, Faculty of Dentistry, University of Szeged, Szeged, Hungary.
authors.forename: Dávid Botond
authors.initials: DB
authors.lastname: Hangyási
authors.affiliation: Professor and Department Head, Department of Cardiology, Petz Aladár County Teaching Hospital, Győr, Hungary. Electronic address: dcsa62@gmail.com.
authors.forename: Csaba András
authors.initials: CA
authors.lastname: Dézsi
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine