Comparative Risk of Bleeding Complication Following Oral Surgical Procedures Between Patients with Continued Aspirin Use Versus Those Without Aspirin Use

Abstract

Objective: To compare risk of bleeding complication following provision of oral surgical procedures in Thai patients with and without aspirin therapy attending public dental service at a district hospital.

Methods: The retrospective cohort approach was adopted using archived routine clinical data of 2,907 consecutive adult patients receiving oral surgical procedures from January 1, 2013 to December 31, 2015 at Huayploo Hospital. The patients were categorized into “index group” receiving continued low-dose aspirin (81 - 300 mg) and “referent group”–not using aspirin. Relative risk of bleeding complication attributed to index group compared to referent group was estimated by generalized linear model for risk ratio regression, controlling for other potential confounders as sex, age, service provider, underlying chronic diseases, involved dental arch, oral surgical procedures, and major dental position in dental arch.

Results: The study found only minor bleeding those could be stopped with local hemostatic measures. The late-onset bleeding was not found. Cumulative incidence of immediate-onset bleeding among patients in the index was 6.6%, which was higher than 0.8% observed in the reference (p<0.001). After adjusting for potential confounders, multivariable analysis estimated that patients in the index group were 6.4 times more likely to have minor bleeding complication to the reference (RR=6.4, 95% CI=2.5 to 16.4, p<0.001).

Conclusion: Clinically significant increase in bleeding risk was observed in patients with underlying chronic condition and uninterrupted aspirin therapy. Nonetheless, oral surgical procedures could be safely performed when close monitoring and local hemostatic measures were well prepared without need to discontinue the aspirin therapy.