Assessment of effects of antitrombosit drugs on bleeding in minor oral surgery procedures

There has been somedebate as to whether, prior to minor oral surgery, anticoagulant treatmentshould be altered or not; the risk of serious postoperative hemorrhage has to bebalanced against the potential for life-threatening thromboembolism. Theliterature does not support the routine with-drawal of anticoagulation therapybefore dental treatment for patients who are taking such medications. Recently,several authors suggested levels of anticoagulation be maintained and that anysubsequent postextraction hemorrhage be treated with local measures. Thepurpose of this study was to investigate whether the most minor oral surgicalprocedures can be carried out safely without stopping long-term aspirintherapy. Fourty-four patients with a long-term aspirin therapy (mean age 63.47±10.79 years, ranging 44 years to 86 years and 22 female and 22 male) wereincluded to study. All patients were divided into two groups with and withoutstopping aspirin before minor oral surgery procedures such as extraction ofteeth, alveoloplasty, limited intraoral soft tissue. Patients stopped theirregimens 7 days before the planned surgical intervention. The control of thebleeding followed up at 15, 30, 60 minutes, 24, 48 hours, 1 week, after theprocedure. The protocol for managing postoperative bleeding consisted of localpressure by gauze soaked was applied for 15 minutes or resorbable gelatinsponge or oxidised regenerated cellulose for 15 minutes or sutures 30 minutesor locally applied tranexamic acid. The mean bleeding time was 2.80±0.83minutes in control group; by comparison, experimental group had a bleedingtime of 4.0±2.94 minutes. All patients? bleeding time except one patient whosebleeding time was 12.3 were with in the normal limits. While in theexperimental group, local hemostatic measures consisted of local pressure bygauze soaked for 15 minutes (46%), using resorbable jelatin sponge and gauzesoaked for 15 minutes (44%), using resorbable jelatin sponge, sutures andgauze soaked for 30 minutes (5%), in the control group, local hemostaticmeasures consisted of local pressure by gauze soaked for 15 minutes (87.5%),using resorbable jelatin sponge and gauze soaked for 15 minutes (12.5%). Therewas no statistically significant postoperative bleeding between two groups. Weconcluded that most minor oral surgery procedures can be carried out safelywithout stopping long-term aspirin regimen.Keywords: Hemostasis, bleeding complications in oral surgery, acetylsalicylicacid