Title Preoperative Continuation of Aspirin with Appropriate Hemostatic Measures Is Currently Recommended
Clinical Question In patients taking daily aspirin as anticoagulant therapy, is it safe to perform dental surgery without withdrawal of aspirin?
Clinical Bottom Line Evidence indicates that appropriate local hemostatic measures are sufficient to control bleeding problems resulting from dental surgery for patients taking daily aspirin.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25767068Zhao/2015 1752 patients in 10 included studies Meta-Analysis
Key resultsThe risk of hemorrhage after tooth extraction was higher in the group continuing their aspirin therapy (relative risk [RR]=2.46; 95% confidence interval [CI]: 1.45-4.81; P= .0009) but the bleeding time of both groups was not significantly different (standardized mean difference [SMD]=0.63; 95% CI:-0.04 to 1.31). Authors recommend improving hemostatic measures along with continuation of preoperative aspirin.
Evidence Search ("aspirin"[MeSH Terms] OR "aspirin"[All Fields]) AND extraction[All Fields]
Comments on
The Evidence
Validity: The meta-analysis (Zhao/2015) includes randomized controlled trials and controlled trials (nonramdomized). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Perspective: This meta-analysis utilized PRISMA guidelines to select studies and conducted sensitivity analyses. The authors only searched the literatures in English and Chinese and may have missed some studies. However, the conclusion of the meta-analysis is adequate to answer the clinical question.
Applicability Aspirin is commonly used as anticoagulant therapy for patients with cardiovascular disease. It is important for dentists to be aware of benefits and risks of continuing preoperative aspirin to minimize the risks of complications: either bleeding or thrombosis.
Specialty (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Aspirin, acetylsalicylic acid, extraction, coagulant
ID# 2850
Date of submission 04/09/2015
E-mail hans3@livemail.uthscsa.edu
Author Sehee Han
Co-author(s) e-mail
Faculty mentor Richard Finlayson, DDS
Faculty mentor e-mail finlaysonr@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
None available