Bleeding evaluation during single tooth extraction in patients with coronary artery disease and acetylsalicylic acid therapy suspension: a prospective, double-blinded, and randomized study.

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.

Bleeding evaluation during single tooth extraction in patients with coronary artery disease and acetylsalicylic acid therapy suspension: a prospective,double-blinded, and randomized study

Purpose: Acetylsalicylic acid (ASA) has been used for the primary and secondary prevention of cardiovascularevents. To reduce bleeding, the administration of ASA has traditionally been suspended before dentalprocedures; however, this suspension potentially increases the risk of thromboembolic events. The effect ofASA on the amount of bleeding that occurs during tooth extraction procedures is controversial, andperioperative guidelines recommend that ASA administration should not be altered for such procedures. Theaim of this study was to evaluate the amount of bleeding that occurs during the intraoperative period of toothextraction 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 extractionwere enrolled in this study. All patients were receiving 100 mg/d of ASA at the time of enrollment and wererandomly placed into 2 groups: group S, which was comprised of patients whose ASA therapy was suspended7 days before tooth extraction, and group NS, comprised of patients whose ASA therapy was unaltered. Aplatelet aggregation test was carried out on the day of the operation, and the amount of bleeding wasmeasured during the intraoperative period by means of aspirated blood collection. All the extractions wereperformed 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 ASAtherapy 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 reportedepisodes of hemorrhaging during the intra- and postoperative periods...

Cardiovascular effects of local anesthesia with vasoconstrictor during dental extraction in coronary patients.

OBJECTIVE: To evaluate the occurrence of variables detecting myocardial ischemia during or after dental treatment under anesthesia with vasoconstrictor (epinephrine). METHODS: A total of 54 coronary patients undergoing dental extraction under local anesthesia with or without vasoconstrictor were included. They were divided into two groups (by drawing envelopes): group I (27 patients) using anesthetics with vasoconstrictor, and group II (27 cases) without vasoconstrictor. 24-hour Holter monitoring, Doppler-echocardiogram before and after dental intervention, and determination of biochemical markers (CK-MB mass, CK-MB activity, and troponin T) before and 24 hours after dental extraction were performed in all patients. Heart rate and blood pressure were also measured in the pre, post-anesthesia and post-dental extraction phases. Doppler echocardiography assessed left ventricular segmental contractility and the occasional occurrence of mitral regurgitation. The usual pharmaceutical treatment prescribed by the cardiologist was maintained in all cases. RESULTS: Three patients in group I presented ST-segment depression (1.0 mm) during administration of anesthesia; two other patients in group I had CK-MB mass elevation, and ischemia was not observed in any other case, as assessed by the other methods. No chest pain, arrhythmias, occurrence or worsening of left ventricular segmental hypocontractility or mitral regurgitation were observed in the study. CONCLUSION: Dental extraction performed under anesthesia with 1:100,000 epinephrine does not imply additional ischemic risks, as long as performed with good anesthetic technique and maintenance of the pharmacological treatment prescribed by the cardiologist.

Efeitos cardiovasculares da anestesia local com vasoconstritor durante exodontia em coronariopatas / Cardiovascular effects of local anesthesia with vasoconstrictor during dental extraction in coronary patients

OBJETIVO: Avaliar a ocorrência de variáveis detectoras de isquemia miocárdica, durante ou após o tratamento odontológico, sob anestesia com vasoconstritor (adrenalina). MÉTODOS: Foram incluídos 54 pacientes coronariopatas submetidos a exodontia sob anestesia local com ou sem vasoconstritor, divididos em dois grupos (sorteio por envelope): grupo I, composto por 27 que receberam anestésico com vasoconstritor; e grupo II, composto por 27 que receberam anestésico sem vasoconstritor. Todos os pacientes foram submetidos a monitoração eletrocardiográfica com Holter por 24 horas, a Doppler-ecocardiografia realizada antes e após intervenção odontológica, e a dosagem dos marcadores bioquímicos antes e 24 horas após a exodontia (creatina cinase fração MB [CK-MB] massa, CK-MB atividade e troponina T). A freqüência cardíaca e a pressão arterial nas fases pré-anestesia, pós-anestesia e pós-exodontia também foram aferidas. A Doppler-ecocardiografia teve como objetivo avaliar a contratilidade segmentar do ventrículo esquerdo e a eventual ocorrência de insuficiência mitral. Em todos os casos foi mantido o protocolo farmacológico habitual prescrito pelo cardiologista. RESULTADOS: Três pacientes do grupo I apresentaram depressão do segmento ST (1,0 mm) durante a aplicação da anestesia, dois outros pacientes do mesmo grupo tiveram elevação da CK-MB massa, e em nenhum caso foi verificada presença de isquemia avaliada pelos demais métodos. Não houve registro, neste estudo, de precordialgia, arritmias e ocorrência ou agravamento de hipocontratilidade segmentar do ventrículo esquerdo ou insuficiência mitral. CONCLUSÃO: A exodontia praticada sob uso de anestesia com adrenalina 1:100.000 não implica riscos isquêmicos adicionais quando realizada com boa técnica anestésica e manutenção do tratamento farmacológico prescrito pelo cardiologista.

OBJECTIVE: To evaluate the occurrence of variables detecting myocardial ischemia during or after dental treatment under anesthesia with vasoconstrictor (epinephrine). METHODS: A total of 54 coronary patients undergoing dental extraction under local anesthesia with or without vasoconstrictor were included. They were divided into two groups (by drawing envelopes): group I (27 patients) using anesthetics with vasoconstrictor, and group II (27 cases) without vasoconstrictor. 24-hour Holter monitoring, Doppler-echocardiogram before and after dental intervention, and determination of biochemical markers (CK-MB mass, CK-MB activity, and troponin T) before and 24 hours after dental extraction were performed in all patients. Heart rate and blood pressure were also measured in the pre, post-anesthesia and post-dental extraction phases. Doppler echocardiography assessed left ventricular segmental contractility and the occasional occurrence of mitral regurgitation. The usual pharmaceutical treatment prescribed by the cardiologist was maintained in all cases. RESULTS: Three patients in group I presented ST-segment depression (1.0 mm) during administration of anesthesia; two other patients in group I had CK-MB mass elevation, and ischemia was not observed in any other case, as assessed by the other methods. No chest pain, arrhythmias, occurrence or worsening of left ventricular segmental hypocontractility or mitral regurgitation were observed in the study. CONCLUSION: Dental extraction performed under anesthesia with 1:100,000 epinephrine does not imply additional ischemic risks, as long as performed with good anesthetic technique and maintenance of the pharmacological treatment prescribed by the cardiologist.