From the Research
For a patient with coronary artery disease on aspirin therapy who needs multiple tooth extractions (approximately 8 teeth), the recommendation is to continue aspirin therapy without interruption. Discontinuing aspirin increases the risk of thrombotic events, which outweighs the slightly increased bleeding risk during dental procedures 1. The dentist should be informed about the patient's medical condition and medication regimen before the procedure. Local hemostatic measures should be employed during and after the extractions, including:
- Pressure packs
- Gelatin sponges
- Oxidized cellulose
- Tranexamic acid mouthwash (4.8% solution used as a rinse for 2 minutes, 4 times daily for 2-5 days) 2
- Careful suturing The procedure should ideally be performed in the morning to allow for management of any potential bleeding complications during office hours. Post-operative instructions should include:
- Avoiding vigorous mouth rinsing for 24 hours
- Soft diet for several days
- Careful oral hygiene If excessive bleeding occurs, the patient should apply pressure with a gauze pack for 20-30 minutes and contact their dentist if bleeding persists. This approach balances the cardiovascular protection provided by aspirin with appropriate measures to minimize and manage potential bleeding complications during extensive dental extractions 3, 4.