Key result
Prasugrel is associated with ~21% longer bleeding times than clopidogrel during dental extraction.
Why the study?
Differences in local bleeding times after dental extraction between clopidogrel and prasugrel in patients on dual antiplatelet therapy were not previously analyzed.
Does prasugrel compared to clopidogrel increase bleeding time after dental extraction in patients on dual antiplatelet therapy?
Cohort (n=129)
Does prasugrel compared to clopidogrel increase bleeding time after dental extraction in patients on dual antiplatelet therapy?
While prasugrel prolongs bleeding time by an average of 10 minutes compared to clopidogrel during dental extraction, the procedure can still be performed safely without interrupting dual antiplatelet therapy.
May warrant extra caution with prasugrel in dental extractions; leaves open the clinical relevance of prolonged bleeding time versus clopidogrel.
PURPOSE: To study the effects of various parameters on local hemostasis after dental extraction in patients receiving different combinations of medications who had previously confirmed effective dual inhibition of platelet aggregation. MATERIALS AND METHODS: A total of 129 patients were enrolled. They underwent acute or planned percutaneous coronary intervention and their stomatological examination disclosed teeth that could have acted as foci and thus had to be removed. All patients took acetylsalicylic acid 100 mg and clopidogrel or prasugrel. Lidocaine with or without epinephrine was used for local anesthesia, and a gauze swab or suture was applied to help hemostasis. RESULTS: Bleeding time was significantly longer by an average of 10 minutes (+21%) in patients taking prasugrel (P < .05) compared with those taking clopidogrel. Use of a suture resulted in a significantly shorter bleeding time after anesthesia with or without epinephrine (P < .05). A considerably longer bleeding time was observed when anesthesia with no epinephrine was combined with gauze. In smokers, the bleeding time was shorter by 15% on average. CONCLUSION: This study is the first to analyze differences in bleeding times between clopidogrel and prasugrel treatments during dental extraction. In general, prasugrel is associated with a considerably longer bleeding time; nevertheless, dental extraction can be performed safely with either combination.
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Dézsi et al. (2015) conducted a cohort in Patients receiving dual antiplatelet therapy undergoing dental extraction (n=129). Prasugrel vs. Clopidogrel was evaluated on Bleeding time (10 minutes longer (+21%), p=<.05). Prasugrel was associated with a significantly longer bleeding time by an average of 10 minutes (+21%) compared with clopidogrel during dental extraction (P < .05).
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