The Effect of Non‐Steroidal Anti‐Inflammatory Drugs on Bleeding During Periodontal Surgery

Abstract

With the increasing prevalence of individuals taking non-steroidal anti-inflammatory drugs (NSAIDs), there is concern as to whether low-dose NSAIDs cause bleeding problems during periodontal surgery. A controlled, single-blind study was designed to measure the effect of ibuprofen at peak plasma levels on intraoperative bleeding. Fifteen medically healthy subjects (seven males and eight females), each having two sites requiring periodontal surgery of similar complexity, type, and duration, were selected for the study. The subjects were instructed to take ibuprofen prior to one of the surgeries. A standard bleeding time and papillary bleeding index score were recorded at initial consultation, and prior to the first and second surgeries. The volume of aspirated blood was measured during each surgery by subtracting the amount of water used for irrigation from the total volume of fluid (blood + irrigation water) collected at 15-minute intervals during the surgery. An analysis of the results showed an increase in intraoperative bleeding when ibuprofen was taken prior to surgery (31.93 +/- 15.72 versus 17.80 +/- 9.57 ml; P <0.01). Ibuprofen appeared to have its greatest effect on bleeding mid-surgery. The average bleeding time also increased significantly (P <0.01) when ibuprofen was preadministered (4.17 +/- 0.96 versus 3.8 +/- 0.92 minutes), although the bleeding remained within the normal range. Papillary bleeding did not show a significant difference between the two surgeries. Surgeries involving osseous resection showed a significant increase in bleeding when ibuprofen was preadministered. Taken prior to periodontal surgery, ibuprofen increases intraoperative blood loss in patients up to almost two times that of those who did not take ibuprofen.