From the Guidelines
Patients with coronary artery disease (CAD) on aspirin therapy should not discontinue their aspirin before a tooth extraction, as the risk of stopping aspirin and potentially triggering a cardiovascular event typically outweighs the risk of increased bleeding during dental procedures 1. The American Heart Association and other reputable organizations have emphasized that antiplatelet therapy, including aspirin, should not be interrupted for dental procedures due to the low risk of significant bleeding and the high risk of cardiovascular complications if therapy is stopped 1.
For most routine dental extractions, patients can safely continue their regular aspirin dosage (usually 81-325 mg daily) without significant increase in bleeding risk. Local hemostatic measures such as pressure, sutures, gelatin sponges, or tranexamic acid rinses can effectively manage any increased bleeding at the extraction site 1. However, for complex or multiple extractions, coordination between the dentist and cardiologist is recommended to create an individualized plan, taking into account the patient's specific cardiovascular risk factors and the potential risks and benefits of continuing or temporarily discontinuing aspirin therapy.
Key considerations in managing patients with CAD on aspirin therapy undergoing tooth extraction include:
- The risk of bleeding associated with aspirin use is generally low and can be managed with local measures during and after the procedure 1.
- The risk of cardiovascular events associated with stopping aspirin therapy in patients with CAD is significant and should be avoided whenever possible 1.
- Effective communication and coordination between the dentist, cardiologist, and patient are essential to ensure that the patient receives optimal care and minimizes the risk of complications 1.
In summary, the current evidence supports continuing aspirin therapy in patients with CAD undergoing tooth extraction, with appropriate management of bleeding risks and close coordination between healthcare providers.
From the Research
Aspirin Therapy and Tooth Extraction in Patients with Coronary Artery Disease
- The use of aspirin in patients with coronary artery disease (CAD) is a common practice for the prevention of thromboembolic events 2, 3.
- However, the decision to discontinue aspirin therapy before a tooth extraction has been a topic of debate due to concerns about bleeding complications.
Bleeding Risk with Aspirin Therapy
- Studies have shown that the risk of bleeding during tooth extraction in patients with CAD who are on aspirin therapy is not significantly increased compared to those who discontinue the therapy 2, 3, 4, 5, 6.
- Local hemostatic methods, such as gauze pressure pack or suturing, are often sufficient to control bleeding in these patients 4, 6.
- The platelet reactivity test has demonstrated a reduction in platelet aggregation in patients who continue aspirin therapy, but this reduction is without clinical consequence 2, 3.
Recommendations for Aspirin Therapy and Tooth Extraction
- The current evidence suggests that aspirin therapy does not need to be discontinued before a tooth extraction in patients with CAD 2, 3, 4, 5, 6.
- A thorough medical history, physician's consent, and coagulation profile should be obtained prior to the procedure to ensure safe management of the patient 6.
- Dental extractions can be performed safely in patients with CAD who are on aspirin therapy, provided that appropriate local hemostasis is used to control bleeding 4, 6.