Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: a randomized clinical trial

Abstract

Objectives

The purpose of this study was to evaluate clinical efficacy of four different local hemostatics in patients taking oral antiplatelet therapy, after multiple dental extractions without discontinuing drugs.

Materials and methods

Study sample included 102 patients (mean age 64.1 ± 17.4 years) in treatment with oral antiplatelet agents needing multiple dental extractions. After surgery, the sockets were randomly sealing with suture alone (control group), hemostatic plug (HEM), advanced platelet-rich fibrin (A-PRF+), and leukocyte-platelet-rich fibrin (L-PRF). Primary outcomes were post-operative bleeding, wound healing index, and possible complications. Secondary outcomes were correlation between primary outcomes and patient’s comorbidities and voluptuous habits. Descriptive statistics, bivariate comparisons, and logistic regression analysis were performed (p < 0.05).

Results

Both A-PRF+ and L-PRF showed a reduced bleeding risk when compared with suture alone (OR = 0.09, p = 0.001 for A-PRF+; OR = 0.09, p = 0.005 for L-PRF). Only L-PRF showed a reduced risk for incomplete wound healing when compared with the control site (OR = 0.43, p = 0.019). Patients affected by hypertension (OR 3.91, p = 0.015) and diabetes (OR 3.24, p = 0.026) had the highest bleeding risk. Smoking (OR 4.30, p = 0.016) and diabetes (OR 3.79, p = 0.007) interfered with healing process.

Conclusion

L-PRF and A-PRF represent a valid alternative to the traditional hemostatics, reducing post-surgical bleeding and promoting wound healing.

Clinical relevance

In patients taking antiplatelet drugs, different local hemostatics are useful to control potential post-operative bleeding and to favor wound healing. However, comorbidities and voluptuous habits may increase bleeding risk, interfering with healing process.

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Authors

Contributions

Conceptualization: Ylenia Brancaccio and Alessandro Antonelli; methodology: Amerigo Giudice, Francesco Bennardo, and Leonzio Fortunato; formal analysis and investigation: Ylenia Brancaccio and Francesco Bennardo; writing—original draft preparation: Ylenia Brancaccio and Alessandro Antonelli; writing—review and editing: Amerigo Giudice and Selene Barone; resources: Selene Barone; supervision: Amerigo Giudice.

Corresponding author

Correspondence to Amerigo Giudice.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The ethical approval was obtained by the Ethical Review Board of Central Calabria (reference for the Magna Graecia University of Catanzaro, Catanzaro, Italy) on 21 September 2017 (Prot. No. 265 of 24 October 2017)

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All patients enrolled for the study signed an informed consent.

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Brancaccio, Y., Antonelli, A., Barone, S. et al. Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: a randomized clinical trial. Clin Oral Invest (2020). https://doi.org/10.1007/s00784-020-03420-3

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Keywords

  • Dental extractions
  • Antiplatelet therapy
  • L-PRF
  • A-PRF
  • Hemostatic agents
  • Wound healing