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Post-extraction bleeding complications in patients on uninterrupted dual antiplatelet therapy—a prospective study

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Abstract

Background

Dental surgeons consider patients on antiplatelet therapy (APT) to be at a risk for perioperative bleeding during dental extraction. This fear often prompts them to consider a temporary withdrawal of the medication for a few days before extraction. Such withdrawal can have serious consequences, especially in patients on dual antiplatelet therapy (DAPT).

Objectives

The purpose of this study was to analyze if patients on uninterrupted DAPT undergoing dental extractions had an increased risk of bleeding complications when compared with patients on no antiplatelet therapy.

Methods

This prospective study included 120 DAPT patients and an equal number of age- and gender-matched non-APT patients undergoing dental extractions. Immediate and delayed bleeding complications in both groups were recorded. Interventions required to control the post-extraction hemorrhage were also analyzed.

Results

Duration of DAPT medication ranged from 6 months to 13 years. Post-percutaneous coronary intervention was the most common cause for DAPT. A vast majority of patients in both groups underwent extraction of one or two teeth. Patients on DAPT had a 7-fold increased risk of immediate bleeding complications when compared with control group. All bleeding episodes were controlled with local hemostatic measures. Transalveolar extractions and localized periodontitis had a significant relationship to bleeding complications.

Conclusion

This study observed an increase in the risk of prolonged bleeding in uninterrupted DAPT patients undergoing dental extractions. Bleeding episodes were amenable to local hemostatic measures with favorable outcomes.

Clinical relevance

Dental extractions in patients on uninterrupted DAPT can be done safely. Resorting to temporary withdrawal of DAPT due to a fear of excessive bleeding is unnecessary.

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Authors and Affiliations

  1. Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), 74, 4th cross, ThanthaiPeriyar Nagar, Pondicherry, 605005, India

    B. Krishnan, G. Arun Prasad, B. Madhan, R. Saravanan, Nirmal Pratap Mote & R. Akilesh

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  1. B. Krishnan
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  2. G. Arun Prasad
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  3. B. Madhan
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  4. R. Saravanan
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  5. Nirmal Pratap Mote
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  6. R. Akilesh
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Correspondence to B. Krishnan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Krishnan, B., Prasad, G.A., Madhan, B. et al. Post-extraction bleeding complications in patients on uninterrupted dual antiplatelet therapy—a prospective study. Clin Oral Invest 25, 507–514 (2021). https://doi.org/10.1007/s00784-020-03410-5

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  • DOI: https://doi.org/10.1007/s00784-020-03410-5

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