70 Cases of Patients with No Stopping Aspirin Research
Xinsheng HUANG1,a , Daofeng LIU1,band Yanbin HUANG1,c
1
Shengli oilfield central hospital
No. 31, Jinan Road #1, Dongying City, Shandong Prov. 257034, China
Keyword: aspirin, tooth extraction, bleed.
Abstract: At present, there are many people with long-term use of aspirin. Before the
tooth extraction, patients should stop using aspirin, but this will increase system
disease risk. Our research team use local treatment without stopping aspirin, and
achieve good hemostatic effect.
1. Instruction
At present, the number of patients who have hypertension, cerebral thrombosis,
coronary heart disease and valvular dysfunction increase year by year, and the patients
should take aspirin for a long time. If the patients have got teeth defect or periodontal
disease, they should stop taking aspirin to recover their function of anticoagulation,
but this may increase the risk of system disease. Since 2005, our research group use
local treatment without stopping aspirin, and achieve good hemostatic effect.
2. Data and method
2.1 clinical data
From 2005 to 2011, there were 70 patients who took tooth extraction with taking
aspirin in Central hospital in Shengli Oil Field. And there were 38 cases of male and
32 cases of female. And the age of the patients was 50 to 72, and the average age was
61.5. There were 20 cases of coronary heart disease, 17 cases of intervention stents
and 33 cases of prevention. All of the patients should take blood routine,
electrocardiogram, blood pressure, blood clotting, blood sugar to exclude acute
myocardial infarction (AMI). And the standard data was shown below.
Table 1 standard data
Test
blood pressure
(mmHg)
Cruor
(s)
APTT
(s)
FBG
(g/L)
INR
Data
100-175/60-100
10.0-14.0
23.0-38.0
2.0-4.0
0.8-1.2%
PA
TT
(s)
Blood
sugar
(mmol/L)
>70%
14.0-18.0
8
The myocardial infarction should never happen, and there was not hematostaxis in the
mouth and digestive tract, and there was not purpura or ecchymosis. And the patients
should be exluded oral infection and ulcers. And 90 teeth were pulled out total.
2.2 method and step
All the patients should not stop taking aspirin. The mouth should be disinfected by
iodine. The mouth should be narcotized by 2% lidocaine. Plier pull technique should
be adopted, and gum should be completely isolated before the tooth extraction. And
granulation should be cleared away after the tooth extraction.
The patients should bite styptic cotton, and processed suture by the condition of the
wound. And the patients should be taken local cold. And the patients could leave after
observing 60min without bleeding. And the patients should take pill to prevent
infection.
3. Results
All the patients were reviewed after two days, and it was happened that 5 cases were
found visible ecchymosis and hematoma which were taken the local anaesthetic
injection, and none of them were found bleeding. And none of the patients were found
serious infection.
4. Discussions
The tooth indication and contraindication is not absolutely correct, and it is based on
the specific condition. Atherosclerosis and the disease of heart head blood-vessel rise
year by year, and the anticoagulation drug (such as aspirin) was taken on a long time,
and it may lead to the tooth bleeding if the doctor do not notice the patients the
instructions. Such bleeding is often for a long time, and it has no special treatment, so
it lead to the fear of the patients and more aggravate bleeding tendency.
Aspirin is also called b phthalic acid, and it belongs to non-steroidal
anti-inflammatory, and its functions is antipyretic, analgesic, anti-inflammatory and
anticoagulation. It is widely used in the remedy of the cold, fever, headache,
rheumatism, cardiovascular and so on. Low concentration aspirin can inactivate b
phthalein of PG synthetase(COX), and it can result in the irreversible inhibition of
platelet cyclase, and it promotes the decreased production of the thromboxane
A2(TXA2), and it influences the formation of the thrombus[1].
Long term use of aspirin can lead to the dysfunction of platelet, reduction of blood
coagulation and bleeding after tooth extraction. To solve the above problems, our
research group first emphasize the check before the tooth extraction, and make the
patients in a healthy state. The doctors should separate the gum before the tooth
extraction, because the gum torn is the main cause of bleeding after the tooth
extraction, and it is difficult to stop bleed with the method of oppression. And the
process of the operation must be soft and fast to reduce the local trauma. The
granulation tissue must be removed from the phatnoma. If the granulation tissue is not
removed thoroughly, it will be difficult to clean up again, and the nest bone quality of
phatnoma which has the granulation tissue will reduce.
Oppression hemostasis, local cooling, filled with gelatin sponge and suture are
adopted after the tooth extraction. The method that the wound is covered with
hemostatic lap and bite oppression can reduce the local blood circulation to stop
bleeding. Local cooling can result capillary contraction around the tooth area, lower
blood flow and lower permeability to stop bleeding. The gelatin sponge is soft,
breathable, stronger adsorption ability and better histocompatibility, and it can be
absorbed slowly by the body. The gelatin sponge is stuffed into the alveolar and it can
absorb many times weight more than its weight, and the blood flow into the sponge to
absorb the blood platelet to have action with coagulation factor to coagulate the blood
platelet. And it can prompt the blood platelet burst at the same time, and it releases
coagulation material to prompt the fibrinogen to fibrin to coagulate blood. The
dissolution and the degradation on the wound of gelatin sponge can change the local
viscosity to prompt the coagulation[2]. The suture can reduce the area of the wound to
stop bleeding. Through the above measure, it can accelerate the coagulation of the
blood to constraint the local bleeding. The method that the local treatment which is
without stopping taking aspirin can constraint the local bleeding. And this method can
solve the oral disease without hinder the treatment of the system disease.
Reference
[1] Loll PJ, Picot D, Garavito RM, et al. The structural basis of aspirin activity
inferred from the crystal structure of inactivated prostaglandin H2 synthase[J].Nat
Struct Biol, 1995, 2(8):637- 643.
[2] Ruiheng Li, Liying Wang, Xu Sun. Application of the Gelatin Sponge Used in
Tears Class Nasal Gel Colostomy. Ent Eye Journal of Shandong university, 2007, 22
(4) : 382-383.