Clinical Trial Evaluating the Risk of Thromboembolic Events During Dental Extractions.
OBJECTIVE
Discontinuation of anti-platelet therapy increases the risk of thrombotic complications whereas its continuation is believed to increase the risk of prolonged post-extraction bleeding. We therefore, performed this study to evaluate the risk of significant bleeding following dental extractions and also to assess the necessity of discontinuing anti-platelet therapy.


METHODS
Three hundred patients requiring dental extraction were included in the study in which 200 patients were on anti-platelet therapy. Patients were divided into three groups of 100 patients each. Group 1 consisted of patients continuing their anti-platelet therapy, Group 2 consisted of patients whose anti-platelet therapy was interrupted and Group 3 comprised of healthy patients not on anti-platelet therapy. Preoperative bleeding and clotting time were determined for all patients. The procedure involved single or multiple teeth (>3 teeth) extractions under local anesthesia with a vasoconstrictor. Pressure pack was given in all cases as in routine dental extractions and bleeding was checked after 15, 30 min, 1, 24, 48 h and 1 week. Immediate post-extraction bleeding was considered to be prolonged if it continued beyond 30 min in spite of the pressure pack. Late and very late bleeding was considered to be clinically significant if it extended beyond 12 and 24 h respectively.


RESULTS
The mean bleeding time in Groups 1, 2, and 3 were 1 min and 32 s, 1 min and 25 s, and 1 min and 27 s, respectively. Prolonged immediate post-extraction bleeding (bleeding after 30 min) was present among 9 patients in Group 1 (9 %) and 15 patients in Group 2 (15 %) whereas it was not seen in any patient of Group 3. Bleeding after 1 h was present in 9 patients of Group 2 (9 %) and was controlled with gelatin sponge within half an hour thereafter. None of the patients in any group reported with bleeding after 24, 48 h and 1 week.


CONCLUSIONS
Dental extractions can be safely carried out in patients on anti-platelet therapy without the risk of significant post-extraction bleeding thus averting the risk of thromboembolic events that might take place on temporary discontinuation of antiplatelet therapy.
Department of OMFS, GITAM Dental College & Hospital, Visakhapatnam, India.
Gokkulakrishnan
G
Sadhasivam
Department of OMFS, GITAM Dental College & Hospital, Visakhapatnam, India.
Satya
S
Bhushan
Department of OMFS, GITAM Dental College & Hospital, Visakhapatnam, India.
Kho Chai
KC
Chiang
Private Practice, Visakhapatnam, India.
Neha
N
Agarwal
Private Practice, Vijayawada, India.
P L
PL
Vasundhar
Anti-platelet therapy; Aspirin and clopidogrel; Dental extraction; Thromboembolic events