DENTOALVEOLAR SURGERY

Hemorrhagic Complications of Dental

Extractions in 181 Patients Undergoing
Double Antiplatelet Therapy
Olga Olmos-Carrasco, MD, FP,* Victoria Pastor-Ramos, MD, PhD, DDS,y
Rafael Espinilla-Blanco, MD, DMD,z Ana Ortiz-Z

arate, MD, DMD,x


Irene Garc
a-Avila,
DMD, PhD,k El
as Rodr
guez-Alonso, MD, DMD,{
Rosario Herrero-Sanju

an, MD, DMD,# Mar
a-Magdalena Ruiz-Garc
a, DMD,**
Paloma Gallego-Beuter, MD, DMD,yy Mar
a-Paz S

anchez-Salgado, MD, DMD,zz
Ana-Isabel Ter

an-Agust
n, MD, DMD,xx Milagros Fern

andez-Behar, MD, DMD,kk
and Inmaculada Pe~
na-Sainz, MD, FP{{
Purpose:

There is limited information on hemorrhagic complications during invasive dental procedures

in patients treated with double antiplatelet therapy. The objective of this study is to assess the frequency of
hemorrhagic complications of patients taking dual antiplatelet medication undergoing dental extractions.

Patients and Methods:

An observational, multicenter, prospective, cohort study was performed in 11

oral and dental care units of primary care. The study sample was derived from the population of patients
aged 18 years or older who were undergoing double antiplatelet therapy and presented to the oral and
dental care units requiring dental extraction. Double antiplatelet therapy is the combination of 100 mg
per day of acetylsalicylic acid and a second antiplatelet agent. The predictor variables were type of extraction performed, number of extracted teeth, number of extracted roots, and presence of inflammation. The
primary outcome variable was intraoperative hemorrhage, and the secondary outcome variables were
hemorrhage at 24 hours and hemorrhage at 10 days. First, a univariate analysis that considered all studied
variables was performed. All variables with P < .25 in the univariate analysis were included in a multivariate
analysis. The association between hemorrhage severity and its relevant factors was evaluated using logistic
regression analysis.

Results:

The study included 181 patients. Light hemorrhage (<30 minutes) was observed in 165 patients
(91.2%). Intraoperative hemorrhage lasted more than 30 minutes in 15 patients (8.3%) and more than 60
yySpecialized in Stomatology, Oral and Dental Care Unit Silvano I,

*Specialized in Family and Community Medicine, Health Center

Jazm
n, Servicio Madrile~
no de Salud, Madrid, Spain.

Servicio Madrile~
no de Salud, Madrid, Spain.

ySpecialized in Stomatology and Maxillofacial Surgery, Oral and

Dental Care Unit Alpes, Servicio Madrile~
no de Salud, Madrid, Spain.

zzSpecialized in Stomatology, Oral and Dental Care Unit Jazm
n,

Servicio Madrile~
no de Salud, Madrid, Spain.
xxSpecialized in Stomatology, Oral and Dental Care Unit Alameda,

zSpecialized in Stomatology, Oral and Dental Care Unit San

Ferm
n, Servicio Madrile~
no de Salud, Madrid, Spain.

Servicio Madrile~
no de Salud, Madrid, Spain.

xSpecialized in Stomatology, Oral and Dental Care Unit Benita de

vila, Servicio Madrile~
A
no de Salud, Madrid, Spain.

Panam
a, Servicio Madrile~

no de Salud, Madrid, Spain.

kkSpecialized in Stomatology, Oral and Dental Care Unit Canal de

{{Specialized in Family and Community Medicine, Health Center

kUniversity degree in Odontology, Oral and Dental Care Unit

Silvano II, Servicio Madrile~
no de Salud, and Assistant Professor,

Jazm
n, Servicio Madrile~

no de Salud, Madrid, Spain.

University Dentistry Clinic, Alfonso X El Sabio University of

Conflict of Interest Disclosures: None of the authors reported any

disclosures.

Madrid, Madrid, Spain.

{Specialized in Stomatology, Oral and Dental Care Unit Dr. Cirajas

Address correspondence and reprint requests to Dr Olmos-

I, Servicio Madrile~
no de Salud, and Associated Professor, Department

Carrasco: Calle de Belice 52, 28027 Madrid, Spain; e-mail: olga.

of Stomatology, Faculty of Health Sciences, Rey Juan Carlos

olmos@salud.madrid.org

University of Madrid, Madrid, Spain.

Received June 4 2014

Accepted August 5 2014

#Specialized in Stomatology, Oral and Dental Care Unit Luis Vives,

2015 American Association of Oral and Maxillofacial Surgeons

Servicio Madrile~
no de Salud, Madrid, Spain.

0278-2391/14/01318-4

**University degree in Odontology, Oral and Dental Care Unit

Daroca, Servicio Madrile~
no de Salud, Madrid, Spain.

http://dx.doi.org/10.1016/j.joms.2014.08.011

203

204

HEMORRHAGIC COMPLICATIONS OF DENTAL EXTRACTIONS

minutes in only 1 patient, whose hemorrhage was controlled by local hemostatic measures. The presence
of inflammation and 3-root extractions increased the probability of hemorrhage persisting for more than
30 minutes by factors of 10 and 7.3, respectively.
Conclusions: In 8.3% of patients treated with dual antiplatelet therapy, dental extractions cause hemorrhagic complications lasting more than 30 minutes are resolved using local hemostatic measures. The results of this study support the safety of dental extraction without withdrawal double antiplatelet therapy.
2015 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 73:203-210, 2015

Double antiplatelet therapy should not be prematurely

stopped after an acute coronary syndrome or a stent
implant because of the risk of myocardial infarction
and death.1 Numerous studies have assessed the
frequency and severity of hemorrhagic complications
of dental interventions in patients undergoing
anticoagulant treatment, antiplatelet monotherapy,
and anticoagulant-antiplatelet combination therapy.2-13
However, information on these complications in
patients with double antiplatelet therapy is scarce.
Few studies include patients with double
antiaggregant therapy, and some have methodologic
deficiencies regarding their small sample size and the
bias inherent to retrospective data collection.5,14-16
Despite this paucity of information, the American
Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Physicians, American
College of Surgeons, American Dental Association, National Health Service, and numerous authors recommend either maintaining double antiplatelet therapy
in dental interventions and applying the necessary
local hemostatic measures to control the hemorrhage
or delaying the intervention until the dual therapy
can be withdrawn without risk.1,17-26
The purpose of this study was to address the
following question: Among patients with double antiplatelet therapy, can dental extractions be carried
out safely? We hypothesized that dental extractions
have a low frequency of hemorrhagic complications
that are resolved using local hemostatic measures.
The specific aims of this study were to estimate the frequency of hemorrhagic complications in dental extractions of patients undergoing double antiplatelet
therapy and to identify factors associated with an
increased risk of intraoperative hemorrhage.

Patients and Methods

STUDY DESIGN

To address the research purpose, we designed and

implemented an observational, multicenter, prospective, cohort study. This project was approved by the
Ethics and Clinical Research Board of Hospital Ram

on
y Cajal and by the Central Research Committee of
Primary Care of the Community of Madrid. The study

was performed in accordance with the Declaration

of Helsinki. Written informed consent was obtained
from all patients before enrollment in the study.
STUDY SAMPLE

The scope of the study included 11 oral and dental

care units of primary care in the community of Madrid
that serve a population of 561,603 persons aged older
than 14 years. Of these, 2,170 persons (0.39%) were
undergoing double antiplatelet therapy at the beginning of the study. The study sample was derived from
the population of patients who were undergoing double antiplatelet therapy and presented to the oral and
dental care units needing dental extraction between
October 1, 2011 and December 31, 2013. Double antiplatelet therapy is the combination of 100 mg per day
of acetylsalicylic acid and a second antiplatelet agent
(clopidogrel, ticlopidine, prasugrel, or ticagrelor).
To be included in the study sample, patients must
have been aged 18 years or older, been treated at least
in the last 7 days, and consented to participate in the
study. Patients were excluded as study patients if they
were aged younger than 18 years, had stopped the single or double antiplatelet treatment for more than 48
hours before extraction, or refused study enrollment.
STUDY VARIABLES

The primary outcome variable was intraoperative

hemorrhage. The secondary outcome variables were
hemorrhage at 24 hours and hemorrhage at 10 days.
Intraoperative hemorrhage was defined as hemorrhage occurring either during the intervention or the
subsequent time the patient spent under observation
during the consultation. The severity of the hemorrhage was classified as a function of its duration and
the measures needed to control it as follows: light
hemorrhage if hemostasis was achieved in less than
30 minutes using the aforementioned protocol, moderate hemorrhage if the bleeding continued for more
than 30 minutes but less than 60 minutes, intense hemorrhage if bleeding continued for more than 60 minutes, and severe hemorrhage when it required
general measures and referral to a hospital. Thus hemorrhage at 24 hours and hemorrhage at 10 days were
classified as absent, light, moderate, intense, or severe.

205

OLMOS-CARRASCO ET AL

We defined the following as predictor variables: type

of extraction performed, number of extracted teeth,
number of extracted roots, presence of inflammation.
Both simple and complex exodontias were performed. The extraction of the tooth from its socket
without damaging it was considered a simple exodontia,
and the procedures in which an osteotomy, odontosection, or elevation of the mucoperiosteal flap was necessary were considered complex.
Inflammation was considered to exist if signs or
symptoms of periodontitis or purulent discharge,
swelling, or erythema of soft tissues were present close
to the tooth. Other patient variables collected included
age, gender, anesthetic technique (infiltration, nerve
block, or both techniques), number of anesthetic cartridges, combination of antiaggregant drugs (acetylsalicylic acid plus clopidogrel, ticlopidine, prasugrel, or
ticagrelor), anticoagulant drugs (yes or no), and intake
of nonsteroidal anti-inflammatory drugs (NSAIDs).
Information collected from patients family doctor clinical file included data regarding excessive alcohol consumption (yes or no), hepatopathology (yes or no),
kidney failure (yes or no), poorly controlled arterial hypertension (yes or no), coagulopathies (yes or no),
chemotherapy (yes or no), and long-term steroid treatment (yes or no). Patients were considered to have undergone NSAID treatment if they had taken the dosage
indicated in the drug technical file during the 24 hours
before the intervention. Each health professionals total
work experience was recorded as well.
INTERVENTION

The extractions were performed by the 11 dentists

of the oral and dental care units, who followed their
usual dental extraction procedures in patients undergoing treatments that interfered with hemostasis. In
all cases 3% mepivacaine without a vasoconstrictor
was the anesthetic used.
Regarding the hemostatic technique, the patient underwent 30 minutes of compression with gauze
impregnated with a 500-mg ampule of tranexamic
acid. If the hemorrhage continued beyond 30 minutes,
the gauze compression with tranexamic acid was
repeated for an additional 30 minutes. The aim of the
application of tranexamic acid is to locally stabilize
the clot formed once the hemostasis phase has ended.
Tranexamic acid forms a reversible complex that displaces plasminogen from fibrin, resulting in inhibition
of fibrinolysis; it also inhibits the proteolytic activity of
plasmin. This technique is part of our usual protocol to
prevent postoperative bleeding in patients undergoing
anticoagulant and antiplatelet therapy requiring dental
extractions.27
After the procedure, the patient received written instructions on recommended home care that included

mouth washing with a 500-mg ampule of tranexamic

acid for 2 minutes, starting 2 hours after the intervention, with repeated washings every 6 hours during the
initial 48 hours after the extraction. In the case of a hemorrhagic episode, the patient was instructed to record
its duration to communicate it at the following consultation. The patient was scheduled for a clinical consultation at 24 hours and 10 days after the intervention, or
a phone inquiry was made to determine whether any
hemorrhagic complications had occurred.
DATA COLLECTION, MANAGEMENT, AND
ANALYSES

A specific protocol was designed to collect data and

included in the electronic clinical record. All data
handling and analysis were performed by the first
author and were analyzed using SPSS statistical software for Microsoft Windows, version 18 (SPSS, Chicago, IL).
Previous research has found a high rate of bleeding
complications that seems far higher than the rates produced in our area.5,14,15 Therefore the sample size
calculation was based on our previous experience,
and a value of approximately 8% was estimated for
hemorrhagic complications lasting more than 30
minutes. The necessary sample size was 164 patients
(a error, 5%; b error, 20%; precision, 4%).
Data are presented as mean  standard deviation for
quantitative variables and as percentage and frequency
distribution for qualitative variables. Age was evaluated as a categorical variable by splitting the patients
into 2 groups: less than 65 years and 65 years or older.
First, a univariate analysis that considered all studied
variables was performed. All variables with P < .25 in
the univariate analysis were included in a multivariate
analysis. Possible interactions were considered and
added to the initial model. The results of the logistic
regression analysis are presented as the odds ratio
and 95% confidence interval.

Results
One hundred eighty-one patients with a mean age of
66.98  12.8 years were included in the study. Most
were male: 139 (76.8%). A total of 217 teeth were extracted, with a mean of 1.2  0.4 teeth per patient. The
most common antiplatelet combination was acetylsalicylic acid, 100 mg per day, and clopidogrel, 75 mg per
day (97.2%). Only 5 patients were treated with 100 mg
per day of acetylsalicylic acid and 10 mg of prasugrel.
INTRAOPERATIVE HEMORRHAGE

During the course of extraction, 165 patients

(91.2%) had light hemorrhage, defined as hemorrhage
lasting less than 30 minutes. In 15 instances (8.3%) the
hemorrhage continued for more than 30 minutes, and

206
1 patient had a hemorrhagic episode exceeding 60 minutes. Hence, intraoperative hemorrhage was classified according to its duration as less than 30 minutes
or more than 30 minutes. Table 1 shows the results
of the descriptive analysis. The single patient with
hemorrhage persisting more than 60 minutes had a
vertical fracture of the extracted tooth, which was a
mandibular molar; granulation tissue had replaced
the bone and vestibular table, and it was necessary
to perform an extensive curettage.
The logistic regression model included the
following variables: years of working experience,
number of anesthetic cartridges, number of extracted
roots, presence of inflammation, and excessive alcohol
consumption. The final model results are shown in
Table 2. Only the presence of inflammation and the
presence of 3-root extractions were found to be risk
factors for intraoperative hemorrhage. Neither working experience time nor excessive alcohol consumption was related to the severity of the hemorrhage.
HEMORRHAGE AT 24 HOURS

At 24 hours, 162 patients (89.5%) reported an

absence of bleeding, 15 (8.3%) had light hemorrhage,
and 4 (2.2%) recounted a bleeding episode lasting
more than 30 minutes that was self-controlled using
the recommended local hemostatic measures. No relevant statistical association was found between hemorrhage severity at 24 hours and the studied factors.
HEMORRHAGE AT 10 DAYS

At 10 days, 174 patients (96.1%) reported an

absence of bleeding and 7 (3.9%) had light hemorrhage that was controlled with local hemostatic measures. No significant statistical association was found
between hemorrhage severity at 10 days and the assessed factors.

Discussion
The purpose of this study was to address the
following question: Among patients with double antiplatelet therapy, can dental extractions be carried
out safely? Our hypothesis was that dental extractions
had a low frequency of hemorrhagic complications.
The specific aims were to estimate the frequency of
hemorrhagic complications in dental extractions of
patients undergoing double platelet antiaggregant
therapy and to identify factors associated with an
increased risk of intraoperative hemorrhage.
The percentage of patients having intraoperative
hemorrhage lasting more than 30 minutes was only
8.3%. The presence of inflammation and the presence
of 3-root extractions increase the probability of hemorrhage. Our results confirm the hypothesis that most

HEMORRHAGIC COMPLICATIONS OF DENTAL EXTRACTIONS

dental extractions can be carried out safely without

stopping dual antiplatelet therapy.
There is no standard definition for hemorrhage
severity after dental extractions. In the existing literature, the method used to measure the severity of hemorrhagic complications is frequently not described,
and there is substantial heterogeneity in the definitions of those that do describe it,3-5,9-16,27 which
complicates the comparison of studies.26 The classification used in this study was based on the duration
of the hemorrhage, which appears to be appropriate
because of its ease of use and adaptation to our
usual protocol.
In a study by Lillis et al,15 66.7% of 33 patients undergoing double antiplatelet therapy had hemorrhage lasting more than 30 minutes. In a study by Ca~
nigral and
Silvestre,5 4 of the 9 patients (44.4%) receiving dual
therapy had moderate hemorrhage that was defined
as hemorrhage lasting more than 10 minutes and was
stopped using local hemostatic measures in less than
60 minutes in all cases. A study from the University
of Korea, by Park et al,16 with all dental extractions
performed in the hospital by the same dentist,
included 100 patients with double and triple antiplatelet therapy, and only 2 cases of excessive hemorrhage
(lasting 4 and 5 hours) were found; however, the authors did not discuss the number of patients with hemorrhage of shorter duration.
In our study there were several circumstances that
may have increased the duration of the bleeding:
 Contrary to the procedure of other
authors,4,9-11,15,16,18,23,25 we used anesthesia
without a vasoconstrictor to avoid adverse
reactions in patients with coronary disease,
whose epinephrine dosage is limited to 0.04 mg
per session.28-30
 Suturing was not included in our dental extraction
protocol.
 We included patients taking oral anticoagulants
and NSAIDs and patients with excessive alcohol
consumption, liver pathology, or renal failure;
such patients are excluded from studies by other
authors because of their increased bleeding
risk.4,10,15,16 We do not advise the use of NSAIDs
in patients with cardiovascular disease and
antiplatelet therapy, but ibuprofen use in our
country is widespread, and often, self-medication
is used in the presence of acute pain.
There also were several circumstances that may
have decreased the duration of the bleeding:
 The compression with gauze impregnated with
tranexamic acid used as the hemostatic technique
likely explains the fact that all cases were

207

OLMOS-CARRASCO ET AL

Table 1. DESCRIPTIVE ANALYSIS OF INTRAOPERATIVE HEMORRHAGE

Intraoperative Hemorrhage, n
Variable
Age
<65 yr
$65 yr
Gender
Male
Female
Combination of antiaggregant drugs
ASA and clopidogrel
ASA and prasugrel
Anticoagulant drug
Acenocoumarol
None
Intake of NSAIDs
Yes
No
Presence of inflammation
Yes
No
Type of extraction performed
Routine exodontia
Complex exodontia
No. of anesthetic cartridges
1
2
3
Anesthetic technique
Nerve block
Infiltration
Both techniques
No. of extracted teeth
1
2
3
No. of extracted roots
1
2
3
4
Liver pathology
Yes
No
Kidney failure
Yes
No
Excessive alcohol consumption
Yes
No
Poorly controlled arterial hypertension
Yes
No
Long-term steroid treatment
Yes
No

Data

<30 Minutes

>30 Minutes

65 (35.9)
116 (64.1)

58
107

7
9

139 (76.8)
42 (23.2)

127
38

12
4

176 (97.2)
5 (2.8)

160
5

16
0

16 (8.8)
165 (91.2)

15
150

1
15

16 (8.8)
165 (91.2)

14
151

2
14

36 (19.9)
145 (80.1)

29
136

7
9

169 (93.4)
12 (6.6)

154
11

15
1

80 (44.2)
89 (49.2)
12 (6.6)

77
76
12

3
13
0

36 (19.9)
131 (72.4)
14 (7.7)

35
118
12

1
13
2

148 (81.8)
30 (16.6)
3 (1.7)

136
26
3

12
4
0

74 (40.9)
61 (33.7)
43 (23.8)
3 (1.7)

72
53
37
3

2
8
6
0

6 (3.3)
175 (96.7)

6
159

0
16

12 (6.6)
169 (93.4)

11
154

1
15

12 (6.6)
169 (93.4%)

9
156

3
13

2 (1.1%)
179 (98.9%)

2
163

0
16

2 (1.1%)
179 (98.9%)

2
163

0
16

P Value
.49

.86

.48

.70

.59

<.001*

.95

.025*

.31

.56

.089*

.44

.95

.041*

.66

.66

208

HEMORRHAGIC COMPLICATIONS OF DENTAL EXTRACTIONS

Table 1. Contd

Intraoperative Hemorrhage, n
Variable
Years of working experience
<15 yr
15-24 yr
$25 yr

Data

<30 Minutes

>30 Minutes

2 professionals
6 professionals
3 professionals

20
122
23

5
8
3

P Value
.072*

Note: Data are presented as number (percent) unless otherwise indicated.

Abbreviations: ASA, acetylsalicylic acid; NSAIDs, nonsteroidal anti-inflammatory drugs.
* Variables with P < .25 in univariate analysis.
Olmos-Carrasco et al. Hemorrhagic Complications of Dental Extractions. J Oral Maxillofac Surg 2015.

controlled by local hemostatic measures without

further need for suture, as other authors have recommended.10,11,15,16,18
 There was a low percentage of complex exodontias (6.6%) in our study compared with studies
nas
by Ca~
nigral and Silvestre5 (38.4%) and Nape~
and Hong14 (51.7%). However, neither our study
nor the study by Ca~
nigral and Silvestre found an
association between the hemorrhage severity
and the type of extraction.
 The mean number of extracted teeth (1.2  0.4)
in our study was lower than that in other
studies.14-16 However, we found no association
between the number of extracted teeth and
hemorrhagic complications, which differs from
other authors.6
Our mean patient age was higher than that in other
studies in which double antiplatelet therapy was
Table 2. MULTIVARIATE ANALYSIS OF
INTRAOPERATIVE HEMORRHAGE*

Variable

OR (95% CI)

Presence of
2.310y 10.07 (2.38-42.54)y
inflammation
No. of extracted
roots
2
1.543 4.68 (0.87-25.17)
3
2.006y 7.34 (1.28-43.31)y
4
18.992
No. of anesthetic
cartridges
2
1.141 3.13 (0.79-12.35)
3
18.259

P Value
.002y
.17
.07
.03y
.99
.27
.10
.99

Abbreviations: CI, confidence interval; OR, odds ratio.

* The Hosmer-Lemeshow statistical test for goodness of fit
yielded P = .99. The 2 log likelihood value equaled 80.97,
and the Cox and Snell R2 value equaled 0.14.
y Statistically significant.
Olmos-Carrasco et al. Hemorrhagic Complications of Dental
Extractions. J Oral Maxillofac Surg 2015.

nigral and
used.5,14-16 In contrast to the study by Ca~
Silvestre,5 it showed no influence on hemorrhage
severity, although statistical significance was not
reached in the former study.
Only 1 of the 16 patients who underwent combined
oral anticoagulantdouble antiplatelet therapy had
hemorrhage lasting more than 30 minutes, and similarly to other studies,10,11 no significant statistical
association with more severe bleeding was found.
The presence of inflammation increased the risk of
hemorrhage persisting more than 30 minutes by a factor of 10. In the study by Lillis et al,15 all patients who
had periodontitis and underwent double therapy had
prolonged bleeding. In studies by Morimoto et al10
and Carter and Goss,27 as well as a review of the literature by Rodr
guez-Cabrera et al,31 a greater frequency
of postoperative hemorrhage also was found in patients undergoing antiplatelet or anticoagulant therapy (or both) with acute inflammation.
Three-root extractions also increased the risk of
moderate hemorrhage, by a factor of 7. In a retrospective study by Svensson et al,32 among 124 patients taking warfarin, all patients with postoperative bleeding
(5 of 124 patients) had undergone a surgical extraction
in the posterior part of the maxilla. In our study 4-root
extractions were performed in only 3 patients, who all
had light bleeding; therefore we were unable to
conclude whether this may be considered as a
risk factor.
Similar to reports from other authors, no relevant
clinical complications were found during the patients
assessments at 24 hours and 10 days after the extractions.14-16

LIMITATIONS AND STRENGTHS

We believe that our results are generalizable

because this study was conducted in oral and dental
care consultations within primary care by 11 different
dentists, without excluding patients who had pathologies that might increase hemorrhagic complications.

OLMOS-CARRASCO ET AL

All the interventions performed were dental extractions, which are the only dental procedures for adults
covered by the Spanish National Health System; therefore our results cannot be extrapolated to other types
of interventions. The mean number of extracted teeth
in our study is low, which may have decreased the
duration of bleeding; however, we found no association between the number of extractions and hemorrhagic complications.
Antiplatelet combinations other than the combination of acetylsalicylic acid and clopidogrel were not assessed because this is the most common combination
in our population (97.2% of patients).
The assessment of other possible pathologies of patients was performed by the dentists during the
consultation by reviewing the patients family doctor
clinical file exclusively, and excessive alcohol consumption or the degree of kidney failure was not quantified in the cases in which it existed. Neither these
patients nor the patients with hepatopathology, longterm steroid treatment, or poorly controlled arterial
hypertension had more hemorrhagic complications,
but the number of these cases was very small and differences might have gone undetected.
Dental extractions in patients receiving double
oral antiplatelet therapy cause an 8.3% rate of hemorrhagic complications exceeding 30 minutes,
which are resolved by local hemostatic measures.
The presence of inflammation and the presence of
3-root extractions increase the probability of hemorrhage. Our results confirm the hypothesis that most
dental extractions can be carried out safely without
stopping dual antiplatelet therapy. Additional
research is needed to assess the frequency of hemorrhagic complications during invasive dental procedures in patients treated with antiplatelet
combinations other than acetylsalicylic acid and clopidogrel, as well as during interventions other than
dental extractions.
Acknowledgments
We thank Drs Ricardo Rodr
guez and Mar
a Jos
e Torijano for their
assistance in the preparation of the manuscript, as well as the
patients for participating in the study.

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