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. 2011 Dec;69(12):2949-55. doi: 10.1016/j.joms.2011.02.139. Epub 2011 Jul 29.


Purpose: Acetylsalicylic acid (ASA) has been used for the primary and secondary prevention of cardiovascular events. To reduce bleeding, the administration of ASA has traditionally been suspended before dental procedures; however, this suspension potentially increases the risk of thromboembolic events. The effect of ASA on the amount of bleeding that occurs during tooth extraction procedures is controversial, and perioperative guidelines recommend that ASA administration should not be altered for such procedures. The aim of this study was to evaluate the amount of bleeding that occurs during the intraoperative period of tooth extraction procedures in patients with coronary artery disease who are either undergoing acetylsalicylic acid (ASA) therapy or who have been instructed to suspend their ASA use.

Patients and methods: Sixty-three patients with coronary artery disease who required tooth extraction were enrolled in this study. All patients were receiving 100 mg/d of ASA at the time of enrollment and were randomly placed into 2 groups: group S, which was comprised of patients whose ASA therapy was suspended 7 days before tooth extraction, and group NS, comprised of patients whose ASA therapy was unaltered. A platelet aggregation test was carried out on the day of the operation, and the amount of bleeding was measured during the intraoperative period by means of aspirated blood collection. All the extractions were performed by the same surgeon, who was unaware of whether the patient's ASA therapy had been suspended.

Results: 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). Local hemostatic methods were sufficient to control bleeding, and there were no reported episodes of hemorrhaging during the intra- and postoperative periods. The platelet reactivity index values exhibited statistically significant differences between the 2 investigated groups (P = .004). The platelet reactivity index values for group S and group NS were 242.58 ± 71.26 and 192.09 ± 60.54, respectively.

Conclusion: There was no difference in the amount of bleeding that occurred during tooth extraction between patients who continued ASA therapy versus patients who suspended their ASA therapy. The platelet reactivity test demonstrated a reduction in platelet aggregation in the ASA therapy group (group NS), but this reduction was without clinical consequence.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aspirin / administration & dosage*
  • Blood Loss, Surgical* / prevention & control
  • Chi-Square Distribution
  • Coronary Disease / drug therapy*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Platelet Aggregation / drug effects
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Platelet Function Tests
  • Practice Guidelines as Topic
  • Prospective Studies
  • Statistics, Nonparametric
  • Thromboembolism / prevention & control
  • Tooth Extraction*


  • Platelet Aggregation Inhibitors
  • Aspirin