%0 Journal Article
%T Dental Extraction Can Be Performed Safely in Patients on Aspirin Therapy: A Timely Reminder
%A Gaurav Verma
%J ISRN Dentistry
%D 2014
%R 10.1155/2014/463684
%X Cardiac patients on aspirin therapy may require extractions for their diseased teeth. It is a common practice among physicians and treating surgeons to stop aspirin prior to tooth extraction because of fear of bleeding complications. This practice often predisposes the patient to adverse thromboembolic events. This practice is based on theoretical risk of bleeding and on isolated case reports of excessive bleeding with aspirin therapy. The current consensus and recommendations are in favor of continuing aspirin therapy during simple tooth extraction as the bleeding complication incidence is very less and if it occurs can be controlled efficiently with local hemostasis measures. 1. Introduction Medical practitioners often advise patients on antiplatelet therapy to either stop or alter their medications prior to invasive surgical procedure because of fear of excessive and uncontrolled bleeding. Although there is increased risk of intraoperative and postoperative bleeding if aspirin is continued, there is increased risk of thromboembolic events such as cerebrovascular accidents and myocardial infarction if medication is altered or discontinued [1]. The purpose of this paper is to spread the message that alteration in aspirin schedule should be based on invasiveness of the surgical procedure and must be individualized. A review of dental literature is presented which establishes the safety of dental extractions in patients on aspirin therapy. 2. Human Physiology and Functions of Platelets The blood is a fluid connective tissue, and hemostatic mechanism is chiefly responsible for stopping the extravasation of blood in case of injury to blood vessels. Classically, hemostasis mechanism is characterized by two consecutive phases: primary and secondary. The primary phase primarily involves the vascular and platelet mediated events that help in early arrest of bleeding as a result of platelet plug formation. Secondary hemostasis phase is mediated by complex cascade of clotting factors which help in formation of fibrin clot to ensure definite sealing of ruptured blood vessels. In normal physiological state, perfect balance exists between coexisting interlinked mechanisms like coagulation/anticoagulation and fibrinolysis/antifibrinolysis. Disturbance in the balance in favor of one mechanism results in either bleeding or thrombosis [2]. There is an inbuilt mechanism in human beings which checks against intravascular coagulation and maintained the blood in fluid state intravascularly. These mechanisms are as follows.(1)The rapid flow of blood keeps coagulation
%U http://www.hindawi.com/journals/isrn.dentistry/2014/463684/