J Prev Med Public Health.  2017 May;50(3):165-176. 10.3961/jpmph.16.121.

Risk of Hemorrhage Attributed to Underlying Chronic Diseases and Uninterrupted Aspirin Therapy of Patients Undergoing Minor Oral Surgical Procedures: A Retrospective Cohort Study

• Rojanaworarit C
• Limsawan S

• KMID: 2384528
• DOI: http://doi.org/10.3961/jpmph.16.121

Abstract

OBJECTIVES
This study aimed to estimate the risk of bleeding following minor oral surgical procedures and uninterrupted aspirin therapy in high-risk patients or patients with existing chronic diseases compared to patients who did not use aspirin during minor oral surgery at a public hospital.
METHODS
This retrospective cohort study analyzed the data of 2912 patients, aged 20 years or older, who underwent 5251 minor oral surgical procedures at a district hospital in Thailand. The aspirin group was comprised of patients continuing aspirin therapy during oral surgery. The non-aspirin group (reference) included all those who did not use aspirin during surgery. Immediate and late-onset bleeding was evaluated in each procedure. The risk ratio of bleeding was estimated using a multilevel Poisson regression.
RESULTS
The overall cumulative incidence of immediate bleeding was 1.3% of total procedures. No late-onset bleeding was found. A significantly greater incidence of bleeding was found in the aspirin group (5.8% of procedures, p<0.001). After adjusting for covariates, a multilevel Poisson regression model estimated that the bleeding risk in the aspirin group was 4.5 times higher than that of the non-aspirin group (95% confidence interval, 2.0 to 10.0; p<0.001). However, all bleeding events were controlled by simple hemostatic measures.
CONCLUSIONS
High-risk patients or patients with existing chronic diseases who continued aspirin therapy following minor oral surgery were at a higher risk of hemorrhage than general patients who had not used aspirin. Nonetheless, bleeding complications were not life-threatening and could be promptly managed by simple hemostatic measures. The procedures could therefore be provided with an awareness of increased bleeding risk, prepared hemostatic measures, and postoperative monitoring, without the need for discontinuing aspirin, which could lead to more serious complications.

Keyword

Aspirin; Oral surgery; Hemorrhage; Platelet aggregation inhibitors; Dentistry; Epidemiology

MeSH Terms

Aspirin*
Chronic Disease*
Cohort Studies*
Dentistry
Epidemiology
Hemorrhage*
Hospitals, District
Hospitals, Public
Humans
Incidence
Odds Ratio
Oral Surgical Procedures*
Platelet Aggregation Inhibitors
Retrospective Studies*
Surgery, Oral
Thailand
Aspirin
Platelet Aggregation Inhibitors