Recovery time of platelet function after aspirin withdrawal.

Current Therapeutic Research 76 (2014) 26–31 Contents lists available at ScienceDirect Current Therapeutic Research journal homepage: www.elsevier.com/locate/cuthre Recovery Time of Platelet Function After Aspirin Withdrawal Jeonghun Lee, MD1, Jeong Kyung Kim, MD, PhD1,n, Jeong Hee Kim, MD1, Tsagaan Dunuu, MD2, Sang-Ho Park, MD3, Sang Joon Park, MD4, Ji Yeon Kang, DDS5, Rak Kyeong Choi, MD6, Min Su Hyon, MD7 1 Cardiovascular Interventional Center, Sun General Hospital, Daejeon, Korea Intensive Care Unit and Department of Emergency, Shastin Central Hospital, Ulaanbaatar, Mongolia 3 Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea 4 Interventional Radiology, Department of Radiology, Sun General Hospital, Daejeon, Korea 5 Department of Oral and Maxillofacial Surgery, Sun General Hospital, Daejeon, Korea 6 Cardiovascular Division of Internal Medicine, Bucheon Sejong General Hospital, Bucheon, Korea 7 Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cardiovascular Institution, Seoul, Korea 2 a r t i c l e in f o abstract Article history: Accepted 20 February 2014 Introduction: Inappropriate antiplatelet therapy discontinuation increases the risk of thrombotic complications and bleeding after dental procedures. To determine the platelet reactivity recovery time after aspirin withdrawal in vivo, our study was conducted in patients with low-risk cardiovascular disease who can stop aspirin administration following the guidelines stipulated by the American College of Chest Physicians. The time it takes for platelet activity to normalize and the diagnostic accuracy of testing methods were assessed for a residual antiplatelet activity with multiple electrode aggregometry. Our study included patients with clinically indicated hypertension preparing for a dental extraction procedure. Materials and methods: A total of 212 patients not taking aspirin (control group) and 248 patients with hypertension receiving long-time aspirin treatment at a 100-mg daily dose were prospectively included in the study, which involved stopping aspirin intake before dental extraction. The residual platelet activity and dental bleeding in patients who stopped aspirin intake were analyzed and compared with those of the control group. In addition, platelet reactivity recovery time and bleeding risk in patients who stopped taking aspirin every 24 hours for 0 to 5 days (0–143 hours) before dental extraction was also assessed. Results: Platelet reactivity normalized 96 hours after aspirin withdrawal. The cut-off value of 49 arbitrary units in the arachidonic acid platelet aggregation test excluded the effect of aspirin with 91% sensitivity and 66% specificity. AUC showed 0.86 (P o 0.001) diagnostic accuracy. The immediate bleeding complications in all treatment groups were similar to those seen in the control group and were successfully managed with local hemostatic measures. Conclusions: The antiplatelet effects of aspirin disappeared 96 hours after aspirin withdrawal in our study, and dental extractions may be safely performed in this period when appropriate local hemostatic measures are taken. Based on these results, a shorter aspirin intake cessation period may be allowable in complex dental procedures and surgery for which a longer aspirin intake cessation period (7–10 days) is recommended based on the American College of Chest Physicians guidelines. & 2014. The Authors. Published by Elsevier Inc. All rights reserved. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). Key words: antiplatelet reactivity dental extraction diagnostic accuracy multiple electrode aggregometry Introduction Platelets play a pivotal role in the pathophysiology of ischemic complications of atherosclerotic cardiovascular disease. Aspirin n Address correspondence to: Jeong Kyung Kim, MD, PhD, Cardiovascular Center, Sun General Hospital, 29 Mokjung-ro, Jung-gu, Daejeon 301-725, Republic of Korea. E-mail address: (J. K. Kim). acts on platelets by acetylating the cyclooxygenase enzyme at position serine 529, resulting in reduced formation of cyclic endoperoxides (prostaglandin G2 and prostaglandin H2) and thromboxane from arachidonic acid. Aspirin is an oral antiplatelet drug commonly used to reduce adverse clinical events across a wide spectrum of patients with atherothrombotic disease.1–3 An increasing number of patients undergoing dental procedures or surgery ingest aspirin. The American College of Chest Physicians (ACCP) recommends that patients scheduled for http://dx.doi.org/10.1016/j.curtheres.2014.02.002 0011-393X/ & 2014. The Authors. Published by Elsevier Inc. All rights reserved. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). J. Lee et al. / Current Therapeutic Research 76 (2014) 26–31 coronary artery bypass grafting continue aspirin intake up to and throughout the time of coronary artery bypass grafting despite published reports of increased risk of perioperative bleeding.4,5 Preoperative aspirin administration increases blood loss during bleeding-sensitive operations.6–8 Thus, ACCP guidelines suggest that patients about to undergo noncardiac surgery who are at low risk for cardiac disease stop aspirin intake 7 to 10 days before surgery. The optimal dental management in patients receiving longterm aspirin treatment has yet to be clearly defined. Antiplatelet discontinuation increases the risk of thrombotic complications, whereas uninterrupted antiplatelet therapy is assumed to increase risk of bleeding after dental procedures. The effect of aspirin on the amount of bleeding that occurs during tooth extraction procedures is controversial, and the perioperative guidelines recommend that aspirin administration should not be altered for such procedures. Dental extraction may be safely performed in patients receiving single or dual antiplatelet therapy when appropriate local hemostatic measures are taken.9 For patients preparing to undergo a dental procedure, detection of the degree of residual-aspirin-induced suppression of platelet activity in accordance with the duration of aspirin withdrawal could not only result in appropriate postponement of complex or bleeding-sensitive dental procedure but also prevent the unnecessary postponement of a simple dental procedure. Multiple electrode aggregometry (MEA) is a newly developed technique for testing platelet function in whole blood based on classic whole-blood impedance aggregometry. It has been used to study the effects of aspirin and clopidogrel on platelet aggregation.10,11 MEA does not require a specialized coagulation laboratory and may be useful for point-of-care analysis.12–14 Up to now, no information has been available regarding the use of MEA for the determination of the time course of platelet inhibition after the ingestion of a single 100-mg dose of aspi (...truncated)