Relative to the article "Does Low-Dose Aspirin Therapy Complicate Oral Surgical Procedures?" by Dr. Leon Ardekian and colleagues in March JADA, I believe the authors have far too little evidence to reach the conclusion that "low-dose aspirin therapy should not be stopped before oral surgery."
Their study group of 39 patients is inadequate to suggest altering what has been accepted as the standard in managing patients who are on low-dose aspirin therapy. The most this study contributes is to consider the wisdom of discontinuing aspirin preceding surgery. Before changing a long-established practice, far more evidence should be at hand.
As the authors point out, intravascular clotting is a serious concern, but this project, involving fewer than 40 patients divided into two groups, is only a clue as to what one might expect by continuing aspirin therapy while carrying out an oral surgical procedure.
Can the authors assure the practitioners they are advising that their 40th patient would not have had a significant increase in bleeding time? In clinical terms, this hypothetical 40th patient might have had severe hemorrhaging.
Granted that embolic formation is a dire event, can the authors assure us that measures to stop bleeding might not make the patient more vulnerable to clotting? Is uninterrupted low-dose aspirin therapy less risky than a few days of discontinuing the aspirin?
These questions are of concern. However, to act on the authors’ proposition—to discontinue low-dose aspirin therapy prior to an oral surgical procedure, mindful of the slight amount of evidence they present—is an injustice to the patient and potentially dangerous.
In my opinion, the only logical conclusion for this study is to suggest that further research is needed. It might be preferable not to interrupt low-dose aspirin therapy in anticipation of an oral surgical procedure, but that has yet to be proven.
This is a legitimate issue, and the authors are correct to question the practice of discontinuing low-dose aspirin therapy. The answer, however, is not in the sparse evidence they presented.
