Should Aspirin therapy be stopped for Routine dental procedures?
From Dr. Cesare Ciavarro, Coronation Dental Specialty Group
Dental patients often present while being treated with different forms of anticoagulation therapy, among which Aspirin remains one of the most commonly encountered drugs.
Aspirin, or Acetylsalicylic Acid (ASA), works as a cyclo-oxygenase inhibitor, thereby blocking prostaglandin and thromboxane production and ultimately preventing platelets from aggregating (1, 2). Besides its anti-inflammatory and analgesic features, this drug can also be used alone or in combination with other anticoagulants to prevent unwanted thrombi, thereby diminishing Cerebrovascular and/or Cardiovascular embolic events. (3, 4)
Nonetheless, there are still many questions regarding the potential bleeding hazards associated with this drug with respect to Dental treatment. As Aspirin is known to affect bleeding times, it is not uncommon for Physicians and Dentists to routinely stop therapy prior to simple dental procedures ranging from restorative work to minor Oral Surgery, such as extractions and implants (5). It is well known that only a fraction of patients on the drug actually have altered bleeding times, and this becomes clinically significant in minor procedures only when local measures are unattainable or neglected (5). As such, it is well established that withholding Aspirin is unwarranted for Oral Surgical and minor Dental procedures, since the literature shows perioperative bleeding is no different in patients who continue the drug when compared with those who have stopped it (5, 6, 7). Unfortunately, the unnecessary practice of routine perioperative withdrawal of Aspirin in these patients may be devastating (8). There are multiple studies showing the long term sequella of short term stoppage from the drug. For example, the percentage of permanently disabling consequences and fatal arterial or venous thromboembolic events after cessation can range from 20 to 40 percent respectively (9).
In nearly 10 years of Clinical practice and throughout my Surgical residency training, I have not withheld Aspirin in any of my patients, regardless of treatment performed in our Oral and Maxillofacial institution. In fact, this remains the standard of care in our practice. As such, our clinicians have yet to encounter any anecdotal issues affiliated with ASA related postoperative bleeding especially when adequate local measures are used.
1. Branco FP; Marcos Pinheiro LP; Volpato MC; Dias de Andrade E. Analgesic choice in dentistry. Part I: The mechanism of action Braz J Oral Sci. July-September 2005 – Vol. 4 – Number 14
2. Pulcinelli FM, Pignatelli P, Celestini A, Riondino S, Paolo Gazzaniga PP, Violi F, Inhibition of platelet aggregation by aspirin progressively decreases in long-term treated patientsJ Am Coll Cardiol. 2004;43(6):979-984
3. Antiplatelet Trialists’ Collaboration [No authors listed]. Collaborative overview of randomised trials of antiplatelet therapy–I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients.. BMJ. 1994 Jan 8;308(6921):81-106.
4. De Gaetano G, Cerletti C, Dejana E, Vermylen J. Current issues in thrombosis prevention with antiplatelet drugs. Drugs. 1986 Jun;31(6):517-49.
5. Pototski M, Amenabar JM. Dental management of patients receiving anticoagulation or antiplatelet treatment. J Oral Sci 2007;49:253-8.
6. Abdullah M. Al-Harkan, , Ghassan A. Al-Ayoub, Should Antiplatelet and Anticoagulant Medications Be Discontinued before Minor Oral Surgery Procedures? J Can Dent Assoc 2012;78:c24
7. Burger, W, Chemnitius, J, Kniessl, GD; Low-dose aspirin for secondary cardiovascular prevention Journal of Internal Medicine 2005; 257: 399–414
8. Kovich, O., Otley, C.C. Thrombotic complications related to discontinuation of warfarin and aspirin therapy perioperatively for cutaneous operation. Journal of the American Academy of Dermatology, 2003
9. Anderson S, Jamrozik K, Broadhurst R and Stewart-Wynne EG . Predicting survival for 1 year among different subtypes of stroke. Results from the Perth Community Stroke Study, Stroke. 1994;25:1935-1944