YIJOM-3701; No of Pages 7 Please cite this article in press as: Buhatem F, et al. Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy, Int J Oral Maxillofac Surg (2017), http://dx.doi.org/10.1016/j.ijom.2017.05.013 Clinical Paper Oral Surgery Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy F. Buhatem Medeiros, N. Pepe Medeiros de Rezende, J. Bertoldi Franco, A. C. Porrio de Andrade, L. Timerman, M. Gallottini, I. L. Itagiba Neves, K. L. Ortega: Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy. Int. J. Oral Maxillofac. Surg. 2017; xxx: xxx–xxx. ã 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. F. Buhatem Medeiros 1 , N. Pepe Medeiros de Rezende 1 , J. Bertoldi Franco 2 , A. C. Porrio de Andrade 3 , L. Timerman 4 , M. Gallottini 1 , I. L. Itagiba Neves 5 , K. L. Ortega 1 1 School of Dentistry, Department of Oral Pathology, University of Sa ˜o Paulo, Sa ˜o Paulo, Brazil; 2 Division of Dentistry, Hospital das Clinicas, Medical School, University of Sa ˜o Paulo, Sa ˜o Paulo, Brazil; 3 Hospital Auxiliar do Cotoxo ´, Hospital das Clinicas, Medical School, University of Sa ˜o Paulo, Sa ˜o Paulo, Brazil; 4 Department of Dentistry, Dante Pazzanese Institute of Cardiology, Sa ˜o Paulo, Brazil; 5 Department of Dentistry, Instituto do Corac ¸a ˜o (InCor), Medical School, University of Sa ˜o Paulo, Sa ˜o Paulo, Brazil Abstract. In spite of the possibility of triggering thromboembolic events, many professionals indicate the suspension of antiplatelet agents before dental surgical procedures. The aim of this study was to perform a quantitative assessment of intraoperative bleeding in patients on dual antiplatelet therapy. A case–control study was conducted in patients on dual antiplatelet therapy (APT group) and in patients who did not use these medications (control group). The following examinations were requested: complete blood cell count, blood coagulation tests, and platelet aggregation. The quantity of bleeding was measured intraoperatively by collection of aspirated blood. The mean volume of blood lost during the surgical procedure was 6.10 ml in the control group and 16.07 ml in the APT group (P = 0.002). The mean volume of blood lost per minute was 0.60 ml/min in the control group and 1 ml/min in the APT group (P = 0.001), with local haemostatic methods being sufficient to control the bleeding. There was no postoperative bleeding complication in any case. Patients on dual antiplatelet therapy presented a larger volume of bleeding, but this could be controlled by means of local haemostatic measures. Therefore, there is no need to stop either of the two dual antiplatelet therapy medications before dental extractions. Key words: platelet aggregation inhibitors; cor- onary artery disease; blood coagulation; hae- m o s t a t i c t e c h n i q u e s ; i n t r a o p e r a t ive complications; dental care for chronically ill; tooth extraction; haemorrhage. Accepted for publication 22 May 2017 Cardiovascular diseases are one of the main causes of morbidity and mortality worldwide 1 . Included in this group are patients with coronary artery disease (CAD), a pathology characterized by ath- erosclerotic plaque accumulation that leads to stenosis of the coronary arteries and thus represents an important risk fac- tor for atherothrombotic accidents 2 . Atherothrombotic events in patients with CAD are prevented with platelet aggrega- tion inhibitors 3 . The use of these may lead to increased bleeding in surgical proce- dures 4 . The platelet aggregation inhibitor acet- ylsalicylic acid (ASA) is the antiplatelet therapy most often used in patients with CAD because it is easily accessible, low Int. J. Oral Maxillofac. Surg. 2017; xxx: xxx–xxx http://dx.doi.org/10.1016/j.ijom.2017.05.013, available online at http://www.sciencedirect.com 0901-5027/000001+07 ã 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.