Professional Documents
Culture Documents
1 January 2015
RESULTS
Postoperative bleeding was only recorded in a total of
7 cases: 5 (1.7%) among the 297 procedures with
continued aspirin therapy and 2 (1.1%) among the 179
procedures on patients not receiving any anticoagulation therapy (Table I). This difference was not
signicant (P .7).
The mean number of the removed molar teeth is
2.5 0.8 for the 7 procedures that had postoperative
bleeding, signicantly larger than that (1.2 0.03,
P < .001) for the 469 procedures that did not have
postoperative bleeding (see Table I). In contrast, the
number of front teeth did not differ signicantly between the two groups (2.5 1.5 vs 1.5 0.1; P .09).
Local measures were sufcient for hemostasis in
all cases. All patients had good wound healing at the
end.
DISCUSSION
With the increasing age of the population in the
industrialized countries, the use of aspirin is becoming
more common. When these patients need oral or
maxillofacial treatment, the surgeon has to outweigh the
risk of heavy surgical bleeding against the risk associated with perioperative cessation of the antiplatelet
treatment. Several studies1-7 favor the interruption of
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January 2015
Two-Sided Fishers
Exact Test or t Test
Features/Parameters
No
Yes
Antiplatelet Therapy
Aspirin
No
Age of Patient (y)
292
177
5 (1.7%)
2 (1.1%)
P .7
68 11
65 20
P .5
277
192
3
4
P .5
1.2 0.03
1.5 0.1
2.5 0.8
2.5 1.5
P < .001
P .09
Gender
Male
Female
Number of Teeth
Molar teeth
Front teeth
aspirin therapy in order to minimize the risk of perioperative bleeding. Studies on cardiac, orthopedic, and
otolaryngologic surgeries have shown an increased
bleeding risk in patients taking medications that alter
platelet function.14-16 Postoperative bleeding has more
serious consequences for surgeries of the abdomen or
thoracic cavity, which have compartment spaces where,
after wound closure, postoperative bleeding is invisible.
In contrast, the consequences of possible hemorrhage
in non-compartment surgeries is greatly outweighed
by the risk associated with cessation of antiplatelet
therapy, which can result in acute coronary syndrome
in serious cases.8-11,13-16 Dental surgery is a noncompartment procedure, and bleeding in the oral cavity
is immediately visible and can therefore be treated
without delay.17,18 Recently, we reported a signicantly
increased bleeding rate (7.4%) for oral surgeries with
continued phenprocoumon anticoagulation.13 However,
all 47 bleeding events were manageable, and more than
95% of them could be resolved by local hemostatic
measures, and only two cases needed an additional
short-term modulation of the anticoagulation therapy.
In contrast to phenprocoumon, we did not nd any
evidence for an increased bleeding risk for dental
osteotomy under continued aspirin therapy. The sample
size of 297 cases and 179 controls in our study is
considerably large. The lack of signicant difference in
the bleeding rates between the two groups therefore
strongly argues against interruption of anticoagulation
therapy with aspirin for dental osteotomy.
Our data adds further solid and reliable evidence
supporting the consensus for continuing antiplatelet
therapy with aspirin for dental procedures, including
osteotomy.19
CONCLUSION
This study emphasizes that continued aspirin therapy
in patients undergoing dental osteotomies has no effect
on the incidence of postoperative bleeding. Dental
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Volume 119, Number 1
ORIGINAL ARTICLE
Hanken et al. 19
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Reprint requests:
Wolfgang Eichhorn
Department of Oral and Maxillofacial Surgery
University Medical Center Hamburg-Eppendorf
Martinistr. 52
D-20246 Hamburg
Germany
mkg-balingen@t-online.de