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Clinical Post-operative Bleeding During Minor Oral Surgical Procedure and In Vitro Platelet Aggregation in Patients on Aspirin Therapy: Are they Coherent?

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Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Aim

The risk of excessive bleeding prompts physicians to discontinue aspirin in patients on low-dose, long-term therapy which in turn puts them at the risk from adverse cardiovascular and thrombotic events. Effect of low-dose aspirin therapy on platelet function was assessed using platelet aggregation method. The aim was to correlate the laboratory platelet function with cutaneous and clinical oral bleeding time (BT).

Materials and Methods

One hundred one patients were enrolled in this prospective trial and were allocated into two groups. Interventional or test group consisted of patients who were on aspirin therapy (75 mg/100 mg) for primary or secondary prevention of angina, myocardial infarction and stroke. Minor oral surgical procedure was performed in this group without discontinuing aspirin therapy. Control group consisted of healthy patients (under no medication) undergoing minor oral surgical procedure. Cutaneous and clinical oral BT were recorded in both the groups. Venous blood sample was drawn, and percentage platelet aggregation function was analysed using adenosine diphosphate (ADP) and arachidonic acid (AA) reagents. The percentage of platelet aggregation was then correlated with cutaneous and clinical oral BT.

Results

A significant decrease in percentage platelet aggregation using ADP (aspirin-74.7 21.39; control-89.2 13.70) and AA (aspirin-47.6 23.11; control-82.3 20.17) was observed. However, there were no significant difference in mean cutaneous BT (aspirin-1.5 0.65 min; control-1.6 0.71 min) and clinical oral BT (aspirin-5.0 2.48 min; control-4.8 2.60 min) in aspirin and control groups.

Conclusion

Majority of the minor oral surgical procedures can be carried out safely without discontinuing aspirin in patients on low-dose long-term therapy. This is possible because despite significant platelet aggregation evident in laboratory evaluation there is lack of its clinical corroboration owing to aspirin resistance.

Clinical Trial Registration

CTRI/2018/02/012055.

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References

  1. De Caterina R, Lanza M, Manca G, Strata GB, Maffei S, Salvatore L (1994) Bleeding time and bleeding: an analysis of the relationship of the bleeding time test with parameters of surgical bleeding. Blood 84(10):3363–3370

    Article  Google Scholar 

  2. Gaspar R, Ardekian L, Brenner B, Peled M, Laufer D (1999) Ambulatory oral procedures in patients on low-dose aspirin. Harefuah 136(2):108–110

    CAS  PubMed  Google Scholar 

  3. Medeiros FB, de Andrade AC, Angelis GA, Conrado VC, Timerman L, Farsky P et al (2011) Bleeding evaluation during single tooth extraction in patients with coronary artery disease and acetylsalicylic acid therapy suspension: a prospective, double-blinded, and randomized study. J Oral Maxillofac Surg 69(12):2949–2955

    Article  Google Scholar 

  4. Canigral A, Silvestre FJ, Canigral G, Alos M, Garcia-Herraiz A, Plaza A (2010) Evaluation of bleeding risk and measurement methods in dental patients. Med Oral Patol Oral Cir Bucal. 15(6):e863–e868

    Article  Google Scholar 

  5. Goodnough LT, Schrier ST (2014) Evaluation and management of anemia in the elderly. Am J Hematol 89(1):88–96

    Article  Google Scholar 

  6. Le Blanc J, Lordkipanidzé M (2019) Platelet function in aging. Front Cardiovasc Med 6:109. https://doi.org/10.3389/fcvm.2019.00109

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Collet J-P, Montalescot G (2006) Premature withdrawal and alternative therapies to dual oral antiplatelet therapy. Eur Heart J Suppl 8(suppl_G):G46–G52

    Article  CAS  Google Scholar 

  8. Ferrari E, Benhamou M, Cerboni P, Marcel B (2005) Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. J Am Coll Cardiol 45(3):456–459

    Article  CAS  Google Scholar 

  9. Sibon I, Orgogozo JM (2004) Antiplatelet drug discontinuation is a risk factor for ischemic stroke. Neurology 62(7):1187–1189

    Article  Google Scholar 

  10. Collet JP, Himbet F, Steg PG (2000) Myocardial infarction after aspirin cessation in stable coronary artery disease patients. Int J Cardiol 76(2–3):257–258

    Article  CAS  Google Scholar 

  11. Collet JP, Montalescot G, Blanchet B, Tanguy ML, Golmard JL, Choussat R et al (2004) Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes. Circulation 110(16):2361–2367

    Article  CAS  Google Scholar 

  12. Biondi-Zoccai GG, Lotrionte M, Agostoni P, Abbate A, Fusaro M, Burzotta F et al (2006) A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J 27(22):2667–2674

    Article  Google Scholar 

  13. Brennan MT, Valerin MA, Noll JL, Napenas JJ, Kent ML, Fox PC et al (2008) Aspirin use and post-operative bleeding from dental extractions. J Dent Res 87(8):740–744

    Article  CAS  Google Scholar 

  14. Olin M (2000) Low-dose aspirin therapy. J Am Dent Assoc 131(10):1398–1401

    Article  CAS  Google Scholar 

  15. Krishnan B, Shenoy NA, Alexander M (2008) Exodontia and antiplatelet therapy. J Oral Maxillofac Surg 66(10):2063–2066

    Article  Google Scholar 

  16. Varghese KG, Manoharan S, Sadhanandan M (2015) Evaluation of bleeding following dental extraction in patients on long-term antiplatelet therapy: a clinical trial. Indian J Dent Res 26(3):252–255

    Article  Google Scholar 

  17. Darawade DA, Kumar S, Desai K, Hasan B, Mansata AV (2014) Influence of aspirin on post-extraction bleeding—a clinical study. J Int Soc Prev Community Dent 4(Suppl 1):S63–S67

    Article  Google Scholar 

  18. Sacco M, Pellegrini F, Roncaglioni MC, Avanzini F, Tognoni G, Nicolucci A (2003) Primary prevention of cardiovascular events with low-dose aspirin and vitamin E in type 2 diabetic patients: results of the Primary Prevention Project (PPP) trial. Diabetes Care 26(12):3264–3272

    Article  CAS  Google Scholar 

  19. Gurbel PA, Bliden KP, DiChiara J, Newcomer J, Weng W, Neerchal NK et al (2007) Evaluation of dose-related effects of aspirin on platelet function: results from the Aspirin-Induced Platelet Effect (ASPECT) study. Circulation 115(25):3156–3164

    Article  CAS  Google Scholar 

  20. Gum PA, Kottke-Marchant K, Poggio ED, Gurm H, Welsh PA, Brooks L, Sapp SK, Topol EJ (2001) Profile and prevalence of aspirin resistance in patients with cardiovascular disease. Am J Cardiol 88:230–235

    Article  CAS  Google Scholar 

  21. Brennan MT, Wynn RL, Miller CS (2007) Aspirin and bleeding in dentistry: an update and recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104(3):316–323

    Article  Google Scholar 

  22. Samson J, Mauprivez C, Alantar A, Perrin D, Tazi M (2004) Management of patients under anti-platelet agents’ treatment in odontostomatology. https://societechirorale.com/documents/Recommandations/recommandations_antiplaquettaires_gb.pdf. Accessed 14 Mar 2020

  23. Grines CL, Bonow RO, Casey DE Jr, Gardner TJ, Lockhart PB, Moliterno DJ et al (2007) Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation 115(6):813–818

    Article  Google Scholar 

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Funding

Funding was provided by AIIMS JODHPUR (AIIMS/IEC/2015/485).

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Authors and Affiliations

  1. Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, India

    Surjit Singh

  2. Department of Transfusion Medicine, All India Institute of Medical Sciences, Jodhpur, Jodhpur, India

    Saptarshi Mandal & Md. Atik Khan

  3. Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Jodhpur, India

    Ankita Chugh, Gaurav Jain & Vinay Kumar Chugh

  4. Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, India

    Surender Deora

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  1. Surjit Singh
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  2. Saptarshi Mandal
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  3. Ankita Chugh
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  4. Surender Deora
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  5. Gaurav Jain
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  6. Md. Atik Khan
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  7. Vinay Kumar Chugh
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Correspondence to Ankita Chugh.

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Singh, S., Mandal, S., Chugh, A. et al. Clinical Post-operative Bleeding During Minor Oral Surgical Procedure and In Vitro Platelet Aggregation in Patients on Aspirin Therapy: Are they Coherent?. J. Maxillofac. Oral Surg. 20, 132–137 (2021). https://doi.org/10.1007/s12663-020-01438-4

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  • DOI: https://doi.org/10.1007/s12663-020-01438-4

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