Title	Vitamin E in Combination With Aspirin Can Pose Potential Postoperative Bleeding
Clinical Question	In a patient undergoing oral surgery, can vitamin E in combination with aspirin pose increased risk of postoperative bleeding?
Clinical Bottom Line	Both articles indicate the enhanced anti-platelet effect of aspirin in combination with vitamin E.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 11940487 Celestini/2002 Healthy Human (blood) taking no medication. In vitro study Key results The anti-platelet aggregation effect of acetylsalicylic acid was enhanced in presence of vitamin E, by increasing the NO(nitrous oxide) production 42 fold(P < 0.05). 16011961 Gonzalez-Correa/2005 Whole blood from healthy male who had not taken any medication at least 15 days prior. In vitro Study Key results Vitamin E(50 and 100 µM) inhibited the aggregation of platelets in aspirin(2-20 µg/mL) treated platelets. The presence of Vitamin E in combination with aspirin required a higher collagen concentration to receive 50% maximal platelet activation. “(7.77±0.38 µg/mL and 10.82±0.46 µg/mL, respectively versus 4.25±1.03 µg/mL of untreated aspirinated-platelets; p< 0.0001)”
Evidence Search	(("Aspirin"[Mesh]) AND "Vitamin E"[Mesh]) AND "Blood Platelets"[Mesh]
Comments on The Evidence	The strength of evidence found in these articles were not significantly valid. None had an obvious competing interest in their trial. None of the articles conducted meta-analysis.
Applicability	It is imperative for Clinician's to be aware and take in to account the possible adverse effect of patients that are taking Vitamin E in combination with aspirin.
Specialty	(Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Dental Hygiene)
Keywords	Vitamin E, Acetylsalicylic acid, collagen, antiplatelet aggregation
ID#	2440
Date of submission	04/01/2013
E-mail	Heydaris3@livemail.uthscsa.edu
Author	Soulmaz Heydari
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Gregory Spackman, DDS, MBA
Faculty mentor e-mail	spackman@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available