Jemds.com Original Article Journal of Evolution of Medical and Dental Sciences/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 4/ Issue 102/ Dec. 21, 2015 Page 16779 IS THE PRACTICE OF DISCONTINUING ASPIRIN THERAPY PRIOR TO DENTAL EXTRACTION CORRECT? A REVIEW Gunjan Chouksey 1 , Jinesh Dugad 2 , Sudip Bhargava 3 , Amrusha Raipure 4 , Sumit Bhargava 5 1 Consultant, Department of Prosthodontics, Fellow Tata Memorial Hospital, Asian Institute of Oncology. 2 Consultant, Department of Prosthodontics, Fellow Tata Memorial Hospital, Asian Institute of Oncology. 3 Senior Resident, Department of Anesthesiology, J. J. Medical College, Mumbai. 4 Assistant Professor, Department of Anesthesia, GMC, Nagpur. 5 Associate Professor, Department of Anesthesia, LN Medical College, Bhopal. ABSTRACT Aspirin is routinely used drug in patients with cardiac problems. When a patient on aspirin requires dental treatment that has the risk of bleeding, the physician or dental surgeon often advices the patient to stop aspirin for few days. This however can lead to thromboembolic events to recur that may cause myocardial infarction, stroke or even death. The decision to stop the medicine prior to dental extraction or oral surgical procedure is critical. KEYWORDS Dental Surgeon, Thromboembolic Events, Analgesic. HOW TO CITE THIS ARTICLE: Gunjan Chouksey, Jinesh Dugad, Sudip Bhargava, Amrusha Raipure, Sumit Bhargava. “Is the Practice of Discontinuing Aspirin Therapy Prior to Dental Extraction Correct? A Review.” Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 102, December 21; Page: 16779-16785, DOI: 10.14260/jemds/2015/2516 INTRODUCTION Aspirin (Acetylsalicylic acid/ASA) is a salicylate drug, routinely used as an analgesic, anti-pyretic, anti-inflammatory and anti-platelet agents in a medical practice. 1 It is known for prevention of arterial thrombosis in both high-risk patients with known occlusive vascular disease and in low-risk healthy patients with no known history of vascular disease. 2 Patients using aspirin are at a high risk for undergoing invasive dental surgical procedures. This is attributed due to the fact of excessive uncontrolled bleeding, hence the decision regarding continuation, modification or discontinuation of aspirin before dental treatment is critical. 3,4 Dental surgeons often asks the patients to stop this drug before dental procedure. 5 However, stopping this medication may lead to thromboembolic events. 6,7,8,9,10 to recur causing myocardial infarction, stroke or even death. 11,12,13 It is important for the dental practitioner to weigh the risk of clinically significant bleeding from an invasive procedure against the risks associated with an alteration in the dose of aspirin. 3,10 This review article emphasizes on the fact that the decision to stop aspirin prior to dental surgery should depend on accurate medical history of the patient, laboratory tests to predict platelet function, invasiveness of surgical procedure and a discussion with the patient’s physician. HISTORY OF ASPIRIN In 1899, a French chemist “Charles Frederic Gerhardt” was the first one who isolated and prepared aspirin and since then it was made commercially available. 14 The name aspirin is derived from an “Acetyl” and Spirin from “Spirsa¨ ure,” an old German name for salicylic acid. 1 In 1950, “Lawrence Craven” prescribed low-dose aspirin (baby aspirin) to his 400 patients and found that none of them developed myocardial infarction. 15 Financial or Other, Competing Interest: None. Submission 25-11-2015, Peer Review 26-11-2015, Acceptance 15-12-2015, Published 21-12-2015. Corresponding Author: Dr. Sumit Bhargava, Associate Professor, Department of Anesthesia, LN Medical College, Bhopal. E-mail: roshanchanchlani@gmail.com DOI:10.14260/jemds/2015/2516 This was probably the first time in medical history where aspirin was used to prevent myocardial infarction. Since then it has become the drug of choice for cardiologists. 16 BLOOD HOMEOSTASIS The blood is a fluid connective tissue and hemostatic mechanism is chiefly responsible for stopping the extravasation of blood in case of injury to the blood vessels. Hemostatic mechanisms are characterized by two consecutive phase. Primary hemostasis phase involving vascular and platelet mediated events that helps in early arrest of bleeding as a result of platelet plug formation. The secondary hemostasis phase is mediated by a complex cascade of clotting factors, which helps in the formation of fibrin clot. In normal physiological state, a 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. 17 Mechanism of Action of Aspirin Aspirin has antiplatelet activity through inhibition of platelet aggregation. Aspirin irreversibly inactivates COX-1 activity by diffusing through the platelet membrane and binding to the catalytic pocket of the enzyme at arginine 120 residue. 14 and acetylating the serine 529 residue. 14,18,19 resulting in reduced formation of cyclic endoperoxides (Prostaglandin G2 and prostaglandin H2) and thromboxane A2. 18,20,21,22 Platelet inhibition activity by aspirin begins at about 1 hour following ingestion. 21,22 and it is irreversible lasting for the lifetime of the affected platelets (Around 7–10 days). 20,21,22 Pharmacokinetics Salicylic acid is a weak acid and very little of it is ionized in the stomach after oral administration. Aspirin is rapidly absorbed from the proximal intestine and stomach and converts to salicylate. It has peak circulating levels within 2 hours after ingestion. 23 the half-life of salicylate is 2 to 15 hours depending on the dosage. 3