5077Safety of dental extractions in patients on single and dual antiplatelet therapy a meta-analysis

Abstract

Introduction: The role of oral antiplatelet therapy (single or dual) on bleeding risk following dental extractions has been a matter of debate and the only scarce evidence available so far has been inconclusive. Fear of bleeding under the above circumstances is common in dentists and patients. Interruption of antiplatelet therapy may in some cases lead to fatal consequences that is why it is important to provide conclusive scientific data in this matter. Aim: The aim of the study was to perform a metanalysis of availalble data in order to assess the risk of bleeding associated with antiplatelet therapy in patients with dental extractions. Methods: A PubMed database research identified 12 publications (until Aug 22, 2017) that fullfiled the search criteria: dual [All Fields] AND antiplatelet [All Fields] AND ("therapy" [Subheading] OR "therapy" [All Fields] OR "therapeutics" [MeSH Terms] OR "therapeutics" [All Fields]) AND ("tooth extraction" [MeSH Terms] OR ("tooth" [All Fields] AND "extraction" [All Fields]) OR "tooth extraction"[All Fields]). Finally, 3 studies were included in the final data analysis. These 3 studies pro-vided similar inclusion and exclusion criteria (eg. liverdisease, alcoholism, previ-ous hemorrhage after tooth extraction, <18 years, anticoagulant therapy, NSAID therapy) as well as unified primary outcome measures definitions (bleeding at extraction site accroding to Lockhart). Network meta-analysis was performed us-ing random-effect model. Overall heterogeneity was assessed using Cochrane's Q. The percentage of variation across studies due to heterogeneity rather than chance was expressed using I2 statistic. Results: There were 2637 patients pooled in the analysis with altogether 42 bleeding events (1.6%). Controls were compared to patients receiving single antiplatelet therapy (ASA or clopidogrel) and dual antiplatelet therapy (ASA+clopidogrel). Results concerning bleeding risk in groups of patients is presented in Figure 1. [Figure Presented] Conclusions: Dental extractions on dual antiplatelet therapy are not associated with significanly higher risk of bleeding in our metanalysis. There is also no such correlation for single antiplatelet therapy with either ASA or clopidogrel.