Should acetylsalicylic acid (ASA) therapy for prevention of thromboembolic events be stopped prior to surgical extractions?

Abstract

Randomised controlled trial. Patients with coronary artery disease who were receiving 100 mg/day of ASA for the prevention of thromboembolic events, and requiring at least one molar tooth extracted were randomised to either having their ASA therapy suspended for seven days before tooth extraction and restarted the day following the surgical procedure or not having their ASA therapy suspended at any point before or after the procedure. A single dentist who was unaware of the patients' ASA therapy status performed all the extractions. Outcomes were a platelet aggregation test carried out on the day of the operation and the amount of bleeding measured during the intra-operative period. Bleeding was controlled with local haemostatic methods and there were no reported episodes of haemorrhaging during the intra- and post-operative periods. The mean (±SD) volume of bleeding was 12.10 ±9.37 mL for patients who underwent ASA therapy suspension and 16.38±13.54 mL for those patients whose treatments were unaltered (P= .151). The platelet reactivity index values exhibited statistically significant differences between the two investigated groups (P= .004). The platelet reactivity index values for the group with ASA therapy suspended was 242.58 ± 71.26 compared with 192.09 ± 60.54 in the group that continued with ASA. There was no difference in the amount of bleeding that occurred during tooth extraction between patients who continued ASA therapy and patients who suspended their ASA therapy. The platelet reactivity test demonstrated a reduction in platelet aggregation in the ASA therapy group, but this was without clinical consequence.