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Gunturu S, Chawla J, Karipineni S, Jayam C. Perioperative management of a patient with systemic lupus erythematosus-associated antiphospholipid syndrome undergoing mandibular third molar surgery. BMJ Case Rep 2024; 17:e259644. [PMID: 39074936 DOI: 10.1136/bcr-2024-259644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
Antiphospholipid syndrome (APS) is a systemic autoimmune condition characterised by recurrent venous or arterial thrombosis and pregnancy complications, with persistent antiphospholipid autoantibodies. APS is often found in conjunction with other autoimmune diseases, such as systemic lupus erythematosus (SLE). SLE-associated APS patients may require dental procedures like tooth extractions. Due to the complex nature of this autoimmune disorder, perioperative management requires a comprehensive approach involving various medical specialists.These patients are frequently taking medications like anticoagulants, antiplatelet drugs, disease-modifying drugs and immunosuppressants. This medication regimen can increase their risk of postoperative complications, including bleeding, thrombosis, delayed healing and postoperative infections. Currently, there are no established guidelines for performing tooth extractions in individuals with SLE-associated APS.We report a case of SLE-associated APS with pericoronitis requiring surgical extraction. The purpose of this report is to offer practical recommendations for the perioperative management of dental procedures and alteration in medications used in such cases.
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Affiliation(s)
- Srikanth Gunturu
- Oral and Maxillofacial Surgery, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Krishna, Andhra Pradesh, India
| | - Jitendra Chawla
- Dentistry, All India Institute of Medical Sciences Mangalagiri, Mangalagiri, Andhra Pradesh, India
| | - Swetha Karipineni
- Oral and Maxillofacial Surgery, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Krishna, Andhra Pradesh, India
| | - Cheranjeevi Jayam
- Dentistry, All India Institute of Medical Sciences Mangalagiri, Mangalagiri, Andhra Pradesh, India
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2
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Abeleira-Pazos MT, García-Mato E, Diniz-Freitas M, Muñoz-Navarro C, Lago-Méndez L, Vázquez-García E, Rivas-Mundiña B. Discrepancy in medications reported by elderly patients in the dental office and in their electronic medical records: A pilot study. SPECIAL CARE IN DENTISTRY 2024; 44:1162-1170. [PMID: 38233963 DOI: 10.1111/scd.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
AIMS This study's main objective was to analyze the discrepancy between the dental medication record (DMR) and the physician-prescribed active medications recorded in the medical medication record (MMR). METHODS The study group consisted of 100 adults who attended the University Dental Clinic (Santiago de Compostela, Spain) requesting dental care. A dental history was created for all participants that included the DMR. The MMR were compiled from their electronic medical records. RESULTS About 80% of the patients consumed at least one drug (94.2% of those >65 years) and 19% took more than five drugs (26.4% of those > 65 years). In total, 54% of the patients had some discrepancy between the medications recorded in the DMR and those in the MMR (48.4% for those ≤65 years and 64.7% for those >65 years). The rate of participants who omitted some drugs was higher for those >65 years. The drugs most omitted from the DMR were analgesics/opioids, antihypertensives and anxiolytics/hypnotics/sedatives. CONCLUSIONS It is imperative to access the MMR of patients requesting dental care because a significant number of medications are not reflected in their DMR. These discrepancies may be particularly common and relevant in elderly patients, in whom multimorbidity and polypharmacy are more frequent.
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Affiliation(s)
- María Teresa Abeleira-Pazos
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Eliane García-Mato
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Márcio Diniz-Freitas
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Carolina Muñoz-Navarro
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Lucía Lago-Méndez
- EOXI Lugo-Monforte-Cervo, Galician Health Service (SERGAS), Chantada, Spain
| | | | - Berta Rivas-Mundiña
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
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3
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Chan MH, Sun F, Malakan J. Controversies in Stoppage of Antiplatelet and Anticoagulant Medications Prior to Oral Surgery. Dent Clin North Am 2024; 68:21-45. [PMID: 37951634 DOI: 10.1016/j.cden.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Dental procedures can pose a risk of bleeding, and it is not uncommon for dentists to consult prescribing physicians regarding a mutual patient's antiplatelet and anticoagulant medication to prevent excessive bleeding during or after an upcoming procedure. However, there has been a growing controversy in the dental community surrounding the stoppage of these medications prior to dental procedures. Some believe that stopping these medications prior to dental procedures is necessary to reduce the risk of bleeding complications, while others argue that stopping them can increase the risk of stroke or other thromboembolic events. The debate has left many dentists and specialists unsure about the best course of action when it comes to managing bleeding risk during dental procedures.In this article, we will review the antithrombotic medications, indications, mechanism of action, and its effects on the coagulation pathway, laboratory testing and reversal agents. Also, we will explore the controversy surrounding the stoppage of novel anitplatelets (eg,: prasurgrel and ticagrelor), dual-antiplatelets, triple-antiplatelet, vitamin K antagonists (eg,: wafarin, coumadin), and direct oral anticoagulants (eg,: dabigatran, rivaroxaban, xarelto and endoxaban) in dentistry and examine the current evidence and guidelines for managing dental patients undergoing oral surgery.
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Affiliation(s)
- Michael H Chan
- Oral & Maxillofacial Surgery, Department of Veterans Affairs, New York Harbor Healthcare System (Brooklyn Campus), 800 Poly Place (Bk-160), Brooklyn, NY 11209, USA; Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue (Box-187), Brooklyn, NY 11201, USA.
| | - Feiyi Sun
- Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
| | - Jonathan Malakan
- Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
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4
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Datta R, Sahoo N, Malhotra N, Godavarthy P, Saxena V, Garg A. Society of Defence Anaesthesiologists review and recommendations for the provision of anaesthesia for elective dental procedures in various echelons of dental care. Med J Armed Forces India 2024; 80:29-40. [PMID: 38239604 PMCID: PMC10793216 DOI: 10.1016/j.mjafi.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/06/2022] [Indexed: 10/16/2022] Open
Abstract
Oral diseases are a burden for developing countries such as India where owing to socioeconomic conditions cost is a factor in selecting the type of treatment. Dental care in India is provided at various levels of care including standalone clinics run by individual dental surgeons, multi-speciality dental centres providing specialist care under one roof including paediatric, prosthodontics, and so on and dental centres affiliated with hospitals having facilities for provision of operation theatre and anaesthesia services. Most dental procedures are performed as day-care procedures requiring local anaesthetics, oral, or moderate intravenous sedation and anxiolytics while maxillofacial procedures are carried out in a controlled operation theatre setting. Dental procedures are fraught with risks due to shared oral surgical space and airway leading to reduced field of visibility to dentists especially with the usage of supplementary oxygenation devices, mouth props, and so on. Various dental societies have proposed minimum standards of care for provision of anaesthesia to various dental procedures; however, there are no extant guidelines in our country. The authors propose these guidelines for provision of minimal sedation (anxiolysis) and moderate sedation/analgesia for various day care dental procedures at various levels of care, keeping the aim that no patient’s life is endangered during provision of anaesthesia services at all dental locations.
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Affiliation(s)
- Rashmi Datta
- Professor & Head (Emergency Medicine), Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - N.K. Sahoo
- Former Professor (Oral & Maxillofacial Surgery) & Director General Dental Services, New Delhi, India
| | - Naveen Malhotra
- Senior Professor & Head (Cardiac Anaesthesia & Pain Management Centre), PGIMS, Rohtak, Haryana, India
| | - Purushotham Godavarthy
- Assistant Professor (Anaesthesiology & Critical Care Medicine), Command Hospital (Western Command), Chandimandir, India
| | - Vivek Saxena
- Senior Specialist (Oral & Maxillofacial Surgery), Army Dental Centre (R&R), New Delhi, India
| | - Anurag Garg
- Associate Professor (Anaesthesiology & Critical Care Medicine), Army Hospital (R&R), New Delhi, India
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5
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Patient Assessment. J Oral Maxillofac Surg 2023; 81:E13-E34. [PMID: 37833021 DOI: 10.1016/j.joms.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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6
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Moldovan MA, Filip LV, Ciurea M, Termure DA, Ostas D, Rotar H, Faur CI, Roman RC. Bleeding and thromboembolic risk in patients under anticoagulant therapy receiving oral surgery: a systematic review. Med Pharm Rep 2023; 96:346-357. [PMID: 37970201 PMCID: PMC10642747 DOI: 10.15386/mpr-2519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 01/16/2023] [Accepted: 02/13/2023] [Indexed: 11/17/2023] Open
Abstract
Background and aims There is an increasing number of patients with cardiovascular diseases who require anticoagulant treatment to address the underlying disease. Types of anticoagulants include vitamin K antagonists, such as warfarin and coumarin derivatives, and also newer oral anticoagulants, including rivaroxaban, apixaban, edoxaban, and dabigatran. The use of these anticoagulants may impact the condition of patients undergoing oral surgery. If the treatment is discontinued, the patient may be at risk of thrombosis. On the other hand, if the treatment is continued, the patient may experience a postoperative bleeding episode, placing them at risk of both thrombosis and bleeding. Method The present article systematically reviews two different therapeutic regimens and their influence on hemorrhagic and thromboembolic events. The review included research from three databases and four specialized journals. The regimens examined were continuous versus discontinuous anticoagulant treatment and continuous versus interruption and switch to bridging therapy. Results The most common surgical procedure examined in the review was tooth extraction, with a few studies also including soft tissue procedures. A total of seven eligible articles were identified, with five using the first treatment regimen of continuous versus discontinuous anticoagulant. These studies reported several cases of bleeding under continuous anticoagulant treatment during surgery. Two articles used the second treatment regimen of continuous versus interruption and switch to bridging therapy. Conclusions The results of both treatment categories (continuous versus discontinuous anticoagulant and continuous versus interruption and switch to bridging therapy) showed no significant differences in terms of bleeding events. However, the use of scores that assess the risk of thrombosis and bleeding can assist surgeons in anticipating the degree of postoperative complications and making informed treatment decisions.
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Affiliation(s)
- Madalina A. Moldovan
- Department of Oral and Cranio-Maxillo-Facial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Laura V. Filip
- Department of Oral and Cranio-Maxillo-Facial Surgery, County Emergency Hospital, Cluj-Napoca, Romania
| | - Mircea Ciurea
- Department of Oral and Cranio-Maxillo-Facial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dragos A. Termure
- Department of Oral and Cranio-Maxillo-Facial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Ostas
- Department of Oral and Cranio-Maxillo-Facial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Rotar
- Department of Oral and Cranio-Maxillo-Facial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cosmin I. Faur
- Department of Maxillofacial Surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rares C. Roman
- Department of Oral and Cranio-Maxillo-Facial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Boccatonda A, Frisone A, Lorusso F, Bugea C, Di Carmine M, Schiavone C, Cocco G, D’Ardes D, Scarano A, Guagnano MT. Perioperative Management of Antithrombotic Therapy in Patients Who Undergo Dental Procedures: A Systematic Review of the Literature and Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5293. [PMID: 37047909 PMCID: PMC10093975 DOI: 10.3390/ijerph20075293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The surgical dental treatment of subjects admitted for anticoagulants therapy represents a consistent risk for peri-operative bleeding. The aim of the present study was to investigate the clinical findings of dental surgery operative management of the patients under anticoagulants drugs protocol. METHODS The literature screening was performed using Pubmed/Medline, EMBASE and Cochrane library, considering only randomized clinical trials (RCTs) papers. No limitations about the publication's period, follow-up time or clinical parameters were considered. RESULTS A total of eight RCTs were included for the qualitative synthesis. No thromboembolic complications were reported in any studies. Several bleeding episodes associated with anticoagulant drugs in dental surgery were mild and generally happened on the first day after the treatment. CONCLUSIONS The use of local haemostatic measures is generally effective for bleeding control with no further pharmacological drug management or suspension.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bentivoglio, Italy
| | - Alessio Frisone
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Calogero Bugea
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Maristella Di Carmine
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Cosima Schiavone
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Giulio Cocco
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Damiano D’Ardes
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
- Department of Oral Implantology, Dental Research Division, College Ingà, UNINGÁ, Cachoeiro de Itapemirim 29312, ES, Brazil
| | - Maria Teresa Guagnano
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
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Ali K, Raja M, Osman S, Zulfiqar G, Janjua O. Recognition and management of drug-associated oral ulceration: a review. Br Dent J 2022; 233:564-568. [PMID: 36241814 DOI: 10.1038/s41415-022-5032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/27/2022] [Indexed: 12/24/2022]
Abstract
The number of people who are using prescribed medications is on the rise, largely due to an ageing population in the UK, but also because of early diagnosis and prompt medical management of a variety of conditions. Systemic medications may contribute to the development of oral side effects and translate into an increasing number of patients presenting in general dental practice settings. The aim of this paper is to provide an outline of oral side effects of systemic medications followed by a review of drug-associated oral ulcers (DAOUs). The paper also provides recommendations for early recognition and management of DAOUs in general dental practice settings, including referral to general medical practitioners and specialists in oral medicine.
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Affiliation(s)
- Kamran Ali
- Professor of Oral Surgery, Qatar University College of Dental Medicine, Qatar; Honorary Professor of Dental Education, Plymouth University, UK.
| | | | - Safa Osman
- Research Assistant, Qatar University, Qatar
| | - Gulraiz Zulfiqar
- Associate Professor, Oral and Maxillofacial Surgery, Jinnah Hospital Lahore, Pakistan
| | - Omer Janjua
- Professor, Oral and Maxillofacial Surgery, Faisalabad Medical University, Faisalabad, Pakistan
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9
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Psillas G, Dimas GG, Papaioannou D, Savopoulos C, Constantinidis J. Epistaxis in dental and maxillofacial practice: a comprehensive review. J Korean Assoc Oral Maxillofac Surg 2022; 48:13-20. [PMID: 35221303 PMCID: PMC8890961 DOI: 10.5125/jkaoms.2022.48.1.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 11/07/2022] Open
Abstract
The lifetime incidence of epistaxis in dental and maxillofacial practice has been reported to be as high as 60% and can be caused by dental implant placement, Le Fort I osteotomy, intranasal supernumerary tooth, odontogenic tumors, blood disorders and maxillofacial trauma. Most epistaxis cases are minor and easily managed with direct compression on the nares for 10 minutes. For more significant or recurrent epistaxis, other techniques might include electrocautery, anterior or posterior nasal packing, or Foley catheter balloon. For patients with refractory epistaxis, cauterization of the sphenopalatine artery under endonasal endoscopy or embolization of the internal maxillary artery should be performed. Epistaxis control is required in patients diagnosed with inherited or acquired bleeding disorders or with drug-induced coagulopathies during dental procedures. In these cases, hemostatic system adjustment and hemostasis achieved by local and adjunctive methods are required. Dentists and maxillofacial surgeons must be aware that the nasal cavity is a potential source of perioperative hemorrhage. Depending on the invasiveness of the dental intervention, preoperative involvement of the hematologist and cardiologist is usually necessary to reverse anticoagulation or to cease anticoagulant therapy.
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Affiliation(s)
- George Psillas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Grigorios Georgios Dimas
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Despoina Papaioannou
- School of Dentistry, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Jiannis Constantinidis
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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10
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Lee S, Guthrie DB, Epstein RH. Kawasaki Disease and General Anesthesia for Dental Treatment: A Case Report. Anesth Prog 2021; 68:146-153. [PMID: 34606572 DOI: 10.2344/anpr-68-01-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/15/2020] [Indexed: 11/11/2022] Open
Abstract
Kawasaki disease (KD) is an acute vasculitis of childhood and is the leading cause of acquired heart disease in children in developed countries. Failure to quickly diagnose and treat patients with KD can result in severe cardiac sequelae, especially coronary artery aneurysms (CAAs). Patients with a prior diagnosis of KD who require general anesthesia (GA) may present unique challenges depending on the severity of any cardiovascular sequelae. This case report describes the perioperative management of a 5-year-old male patient previously diagnosed with incomplete KD approximately 1 year before presenting to Stony Brook University Hospital for full mouth dental rehabilitation under GA. Most uniquely, the patient was at high risk for coronary artery thrombosis due to a giant CAA of his right coronary artery and a small CAA of his left anterior descending artery. The discussion also includes the implications of dental treatment under GA for patients with a history of KD.
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Affiliation(s)
- Sarah Lee
- Department of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Stony Brook, New York.,Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - David B Guthrie
- Department of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Stony Brook, New York.,Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Ralph H Epstein
- Department of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Stony Brook, New York.,Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
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11
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Yu H, Zhou A, Liu J, Tang Y, Yuan Q, Man Y, Xiang L. Management of systemic risk factors ahead of dental implant therapy: A beard well lathered is half shaved. J Leukoc Biol 2021; 110:591-604. [PMID: 34231923 DOI: 10.1002/jlb.6mr0621-760rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
As the most successful therapy for missing teeth, dental implant has become increasingly prevalent around the world. A lot of papers have reported diverse local risk factors affecting the success and survival rate of dental implants, either for a short or a long period. However, there are also many types of systemic disorders or relatively administrated medicine that may jeopardize the security and success of dental implant treatment. Additionally, the coronavirus disease 2019 pandemic also poses a challenge to dental implant clinicians. Some of these risk factors are clinically common but to some extent unfamiliar to dentists, thus optimal measurements are often lacking when they occur in dental clinics. In this review, we analyze potential systemic risk factors that may affect the success rate of dental implants. Some of them may affect bone mineral density or enhance the likelihood of local infection, thus impeding osseointegration. Others may even systemically increase the risk of the surgery and threaten patients' life. In order to help novices receive high-risk patients who need to get dental implant treatment in a more reasonable way, we accordingly review recent research results and clinical experiments to discuss promising precautions, such as stopping drugs that impact bone mineral density or the operation, and addressing any perturbations on vital signs.
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Affiliation(s)
- Hui Yu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Anqi Zhou
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiayi Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yufei Tang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Quan Yuan
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Man
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Xiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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12
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Miziara LNB, Sendyk WR, Ortega KL, Gallottini M, Sendyk DI, Martins F. Risk of Bleeding during Implant Surgery in Patients Taking Antithrombotics: A Systematic Review. Semin Thromb Hemost 2021; 47:702-708. [PMID: 33971681 DOI: 10.1055/s-0041-1722845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this systematic review is to assess the risk of postoperative bleeding in oral surgery for implant placement in individuals taking antithrombotics (i.e., anticoagulants and/or antiplatelet agents). A literature search was performed in PubMed (MEDLINE), Web of Science, Scopus, and EMBASE databases for articles published until August 2020, with no date restriction, and manually completed. We included prospective clinical studies that provided information regarding the presence of an experimental group (i.e., implant placement), a control group (patients not under treatment with antithrombotics), and a well-established protocol for evaluating bleeding. Meta-analysis determined the risk of bleeding during the placement of implants in antithrombotic-treated patients. Of the 756 potentially eligible articles, 5 were included in the analysis with 4 ranked as high and 1 as medium quality. Antithrombotic treatment comprised the following drug classes: (1) anticoagulants: vitamin K antagonists, (2) nonvitamin K antagonist oral anticoagulants, (3) low-molecular-weight heparin, and (4) antiplatelet agents (not specified). The results suggest that the risk of bleeding is not substantially higher in antithrombotic-treated patients (odds ratio = 2.19; 95% confidence interval: 0.88-5.44, p = 0.09) compared with nontreated patients. This systematic review suggests that the absolute risk is low and there is no need to discontinue or alter the dose of the antithrombotic treatment for implant placement surgery.
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Affiliation(s)
| | - Wilson Roberto Sendyk
- Department of Oral Implantology, Dental School, University of Santo Amaro, São Paulo, Brazil
| | - Karem López Ortega
- Division of Oral Pathology, Department of Stomatology, Dental School, University of São Paulo, São Paulo, Brazil
| | - Marina Gallottini
- Division of Oral Pathology, Department of Stomatology, Dental School, University of São Paulo, São Paulo, Brazil
| | - Daniel Isaac Sendyk
- Division of Periodontics, Department of Stomatology, Dental School, University of São Paulo, São Paulo, Brazil
| | - Fabiana Martins
- Department of Oral Implantology, Dental School, University of Santo Amaro, São Paulo, Brazil
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Tateno RY, Palma LF, Sendyk WR, Campos L. High-Power Diode Laser for Second-Stage Implant Surgery in an Anticoagulated Patient: A Clinical Case Letter. J ORAL IMPLANTOL 2021; 47:154-157. [PMID: 32663276 DOI: 10.1563/aaid-joi-d-20-00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ricardo Yudi Tateno
- Department of Post-Graduation in Implantology, School of Dentistry, University of Santo Amaro. São Paulo, SP, Brazil
| | - Luiz Felipe Palma
- Department of Morphology and Genetics, Federal University of São Paulo. São Paulo, SP, Brazil.,MSc Program, Ibirapuera University. São Paulo, SP, Brazil
| | - Wilson Roberto Sendyk
- Department of Post-Graduation in Implantology, School of Dentistry, University of Santo Amaro. São Paulo, SP, Brazil
| | - Luana Campos
- Department of Post-Graduation in Implantology, School of Dentistry, University of Santo Amaro. São Paulo, SP, Brazil.,Oral Medicine. Brazilian Institute of Cancer Control. São Paulo, SP, Brazil
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Lewandowski B, Myszka A, Migut M, Czenczek-Lewandowska E, Brodowski R. Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study. BMC Oral Health 2021; 21:31. [PMID: 33451310 PMCID: PMC7809775 DOI: 10.1186/s12903-021-01391-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Patients using antiplatelet drugs following infarctions, acute coronary syndrome or stroke pose a significant clinical problem if it is necessary to perform surgery, including dental surgery, since they are at risk of prolonged or secondary post-extraction bleeding. Discontinuation of this therapy is associated with a high risk of serious thromboembolic complications. The purpose of this study was to assess the effectiveness of TachoSil fibrin-collagen patches in stopping and preventing of secondary post-extraction bleeding in patients undergoing chronic antiplatelet therapy. Methods The study was conducted through retrospective examination of the medical records of 153 patients using chronic antiplatelet therapy and those qualified for tooth extraction. The largest group comprised 74 patients using aspirin and clopidogrel as dual platelet antiaggregation therapy; in this group 75 tooth extractions were carried out. In all of the patients TachoSil fibrin-collagen patches and stiches were applied to the wounds resulting from tooth removal. Results Following tooth extraction, primary bleeding was stopped in all the patients and their wounds closed via coagulation within 20–30 min. In eight cases, accounting for 4.9% of the patients, secondary bleeding occurred and was successfully stopped only by applying a pressure dressing soaked in tranexamic acid. Secondary bleeding occurred in three patients on the second day and in five patients on the third day following tooth removal. Conclusion Topical application of TachoSil patches following tooth removal in patients using single or dual antiplatelet therapy effectively stopped bleeding and prevented secondary bleeding after tooth extraction.
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Affiliation(s)
- Bogumił Lewandowski
- Medical College, University of Rzeszow, Rzeszow, Poland. .,Departament of Maxillofacial Surgery, Fryderyk Chopin Clinical State Hospital, Rzeszow, Poland.
| | | | - Małgorzata Migut
- Medical College, University of Rzeszow, Rzeszow, Poland.,Departament of Maxillofacial Surgery, Fryderyk Chopin Clinical State Hospital, Rzeszow, Poland
| | | | - Robert Brodowski
- Departament of Maxillofacial Surgery, Fryderyk Chopin Clinical State Hospital, Rzeszow, Poland
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Pippi R, Scorsolini MG, Luigetti L, Pietrantoni A, Cafolla A. Tooth extraction without discontinuation of oral antithrombotic treatment: A prospective study. Oral Dis 2020; 27:1300-1312. [PMID: 32920926 DOI: 10.1111/odi.13641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify which variable, among those related to surgeries, to patients, or to antithrombotic treatments, could be considered as a bleeding indicator, and to analyze effectiveness of the local hemostatic protocols used, incidence of bleeding and healing index, depending on the number of extracted teeth, and patient antithrombotic treatment. METHODS Patients who underwent tooth extractions without interruption or reduction of antithrombotic treatment were prospectively followed. The exact two-tailed Fisher test was used to investigate the relationship between presence/absence of bleeding and type of hemostatic material. The effect of variables on the probability of bleeding and healing index was assessed by means of a multivariate logistic regression. RESULTS Two hundred and fifty-four procedures were analyzed. The incidence of bleeding was 15.75%. Severe bleeding occurred in only 6 patients (2.34%). The number of involved dental quadrants and pre-surgical antibiotic treatments were found to be positively related with bleeding. The use of vasoconstrictors during surgery resulted in a reduction of healing index scores. CONCLUSIONS Tooth extractions in patients on antithrombotic treatment were found to be free from significant bleeding although the involvement of more than 1 quadrant in the same procedure should be avoided.
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Affiliation(s)
- Roberto Pippi
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Giulia Scorsolini
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Luigetti
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra Pietrantoni
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
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16
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Ibdah RK, Rawashdeh SI, Harahsheh E, Almegdadi A, Al. Ksassbeh A, Alrabadi N. The Knowledge and Perception of Antiplatelet and Anticoagulant agents among Dentists in Northern Jordan. J Int Soc Prev Community Dent 2020; 10:597-604. [PMID: 33282769 PMCID: PMC7685271 DOI: 10.4103/jispcd.jispcd_70_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe the attitude and perception toward antiplatelet/anticoagulant agents in patients with cardiovascular diseases among dentists in the northern district of Jordan and to compare the current practice of Jordanian dentists and the recently published guidelines regarding the management of patients taking antiplatelet/anticoagulant drugs before dental procedures. MATERIALS AND METHODS This is a cross-sectional study conducted on dentists and dental interns working at the dental clinics in northern Jordan, including dental clinics at Jordan University of Science and Technology (JUST) and the private sector. The total sample size comprised of 128 subjects (78 dentists from JUST and 50 private practitioners). The participants were interviewed using a preformed questionnaire to assess their knowledge and perceptions regarding the antiplatelets and the anticoagulant agents. RESULTS Approximately 61.5% of participants from JUST university and 20.0% of those in the private sector were aware of the use of clopidogrel (P < 0.0001). Although the overall awareness regarding other antiplatelets such as prasugrel was very low (8.6%), dentists from JUST (12.8%) showed a significantly higher level of awareness compared to the private practitioners (2.0%) (P = 0.049). More than 70% of the participants from JUST and only 46.0% of the private practitioners were aware of the consequences of interrupting treatment with clopidogrel in patients with coronary stents (P = 0.002). Almost both the participants from JUST (25.78%) and the private sector (24.22%) are consulting the cardiologists with similar frequencies before interrupting the treatment with the antiplatelet/anticoagulant agents. Participants who have clinical PhD qualifications are more aware of the recent clinical guidelines and the newest agents compared to others. CONCLUSIONS The awareness regarding the newest antiplatelet/anticoagulant agents is poor among the dentists in northern Jordan. However, the majority (62.3%) of them realize the consequences of interrupting such treatments in patients with coronary stents. Unfortunately, only a quarter of the dentists are consulting the cardiologists before interrupting the treatment with the antiplatelet agents. Proper education, courses, and workshops should be performed to the dentists to improve their knowledge about this critical issue.
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Affiliation(s)
- Rasheed K Ibdah
- Division of Cardiology, Department of Internal Medicine, Jordan University for Science and Technology, Irbid, Jordan
| | - Sukaina I Rawashdeh
- Division of Cardiology, Department of Internal Medicine, Jordan University for Science and Technology, Irbid, Jordan
| | - Ehab Harahsheh
- Department of Neurology, Mayo Clinic College of Medicine, Arizona, USA
| | - Abdallah Almegdadi
- Division of Cardiology, Department of Internal Medicine, Jordan University for Science and Technology, Irbid, Jordan
| | - Abdullah Al. Ksassbeh
- Division of Cardiology, Department of Internal Medicine, Jordan University for Science and Technology, Irbid, Jordan
| | - Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Lupi SM, Baena ARY. Patients Taking Direct Oral Anticoagulants (DOAC) Undergoing Oral Surgery: A Review of the Literature and a Proposal of a Peri-Operative Management Protocol. Healthcare (Basel) 2020; 8:healthcare8030281. [PMID: 32825272 PMCID: PMC7551164 DOI: 10.3390/healthcare8030281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022] Open
Abstract
Patients on anticoagulant therapy for the prevention of cardiovascular accidents present an increased risk of bleeding following dental and oral surgery. Four recently introduced non-vitamin K antagonist oral anticoagulants, namely dabigatran etexilate (direct thrombin inhibitor), rivaroxaban, apixaban, and edoxaban (Xa factor direct inhibitor), are widely spreading for convenience of use compared to the older drug class. Dental management of patients taking these drugs has substantial differences compared to patients on vitamin K antagonist therapy. Anticoagulation is not assessed directly through a hematological test, but indirectly by renal function. The interventions must be scheduled at the time of minimum blood concentration of the drug. Bleeding can occur even after several days following the surgery. The interaction with drugs administered for dental care must be carefully evaluated. The peri-operative diet can influence the risk of bleeding. Local measures favoring coagulation must be adopted. The interventions with higher risk must be divided into multiple less invasive interventions. Although antidotes exist for these drugs, their use does not seem necessary for dental interventions that have been planned optimally. Furthermore, in this review of the literature a decision protocol is proposed for the evaluation of the suspension of the anticoagulant drug before oral surgery. Cessation of any anticoagulant should only be made in consultation with the patient’s general practitioner/cardiologist, who will weigh up the risk of bleeding from the proposed procedure with the risk of thrombosis/stroke in each individual patient.
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Affiliation(s)
- Saturnino Marco Lupi
- Department of Clinical Surgical, Pediatric and Diagnostic Sciences, University of Pavia, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-382-516-255
| | - Arianna Rodriguez y Baena
- Department of Dentistry, IRCCS San Raffaele Hospital, 20123 Milan, Italy;
- Dental School, Vita Salute University, 20132 Milan, Italy
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Yang JH, Chen HM, Kuo YS, Chiang CP. Management of patients taking antithrombotic drugs before dental surgery. J Dent Sci 2020; 15:222-224. [PMID: 32595905 PMCID: PMC7305421 DOI: 10.1016/j.jds.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Indexed: 01/28/2023] Open
Affiliation(s)
- Ju-Hsuan Yang
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsin-Ming Chen
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Ying-Shiung Kuo
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Pin Chiang
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Continuation of antithrombotic therapy increases minor bleeding but does not increase the risk other morbidities in open inguinal hernia repair: A propensity score-matched analysis. Hernia 2020; 24:857-865. [PMID: 32162110 DOI: 10.1007/s10029-020-02169-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE An aging population has led to an increased number of patients with cardiovascular comorbidities requiring antithrombotic therapy. Perioperatively, surgeons should consider the increased risk of bleeding and thrombotic events in patients continuing or discontinuing these medications. We aimed to analyze the safety of continued antithrombotic therapy during open inguinal hernia repair. METHODS In this single-center, retrospective study, 4870 adult patients who underwent open inguinal hernia repair surgery by the same surgeon from 2008 January to 2019 March were included. Patients who underwent surgery while continuing antithrombotic therapy were included in the antithrombin group (n = 523) while those who were not under any antithrombotic therapy during the surgery were included in the control group (n = 4333). Using propensity score-matching, we then selected patients from each group with similar backgrounds. Surgery time, anesthesia time, postoperative bleeding, reoperation, and thrombotic event data were compared between the groups. Subgroup analysis based on the type of medications used was performed within the antithrombin group. RESULTS Ten patients in the antithrombin group and seven patients in the control group experienced postoperative bleeding (p < 0.001). The rate of postoperative bleeding was the highest in patients taking multiple medications. However, most were managed conservatively. Three patients from the antithrombin group experienced thrombotic events postoperatively (p = 0.001). CONCLUSIONS Patients receiving continued antithrombotic therapy had an increased risk of minor postoperative bleeding; however, they are a high-risk group for thrombotic events.
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MENEZES LDS, DE OLIVEIRA RLB, DA SILVA LCF. Avaliação do nível de conhecimento de cirurgiões-dentistas e graduandos em Odontologia quanto ao manejo de indivíduos em uso de anticoagulantes orais. REVISTA DE ODONTOLOGIA DA UNESP 2018. [DOI: 10.1590/1807-2577.09718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução Diante da alta incidência das doenças cardiovasculares, muitos são os pacientes que fazem uso de medicações para prevenção e tratamento dessas desordens. Consequentemente, o número de pessoas em uso de anticoagulantes orais a serem submetidas a tratamento odontológico é crescente e o manejo desses indivíduos requer criteriosa avaliação da condição clínica e do procedimento a ser realizado. Objetivo Avaliar o nível de conhecimento de cirurgiões-dentistas e graduandos em Odontologia quanto ao manejo de indivíduos em uso de anticoagulantes orais a serem submetidos a tratamento odontológico. Material e método Investigação descritiva, quantitativa, de corte transversal, com base em um questionário respondido por 100 indivíduos, sendo 70 cirurgiões-dentistas e 30 graduandos do curso de Odontologia, escolhidos por conveniência, para avaliar o conhecimento sobre o tema proposto. Para comparação das variáveis quantitativas, foi utilizado o Teste t de student, para comparação de duas amostras, e o Teste ANOVA, com pós-teste de Bonferroni, para comparação de três amostras. Resultado Dentre os entrevistados, 74,5% dos cirurgiões-dentistas e 54,2% dos graduandos relataram já ter atendido um paciente que faz uso de anticoagulante oral. Não houve diferença estatística quanto ao desempenho entre profissionais e alunos acerca do manejo odontológico de pacientes em uso de anticoagulantes. Dentre o grupo de cirurgiões-dentistas, os profissionais da cirurgia bucomaxilofacial e os que fizeram residência multiprofissional apresentaram melhor desempenho quando comparados aos clínicos gerais. Conclusão Pôde-se concluir que, para os grupos estudados, o manejo de pessoas em uso de anticoagulantes orais ainda é um desafio.
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Bensi C, Belli S, Paradiso D, Lomurno G. Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2018; 47:923-932. [PMID: 29627150 DOI: 10.1016/j.ijom.2018.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/15/2018] [Accepted: 03/18/2018] [Indexed: 01/24/2023]
Abstract
Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban; DOACs) have been introduced to improve safety and superior therapeutic value compared to their predecessors such as warfarin or enoxaparin. The aim of this systematic review and meta-analysis was to assess the postoperative bleeding risk of DOACs during oral surgery procedures. Systematic searches were performed in electronic databases including PubMed, Scopus, Web of Science and Cochrane Library. Thirteen studies were included in the qualitative synthesis: two retrospective case-control studies, five prospective case-control studies, three cross-sectional studies, two case series and a case report; while only six studies were statistically analysed. The risk ratio of postoperative bleeding in DOACs patients was significantly greater than in healthy patients (3.04; 95% confidence interval (CI)=1.31-7.04). This is especially true for rivaroxaban (4.13; 95% CI=1.25-13.69), and less so for dabigatran which presented a risk ratio similar to that of healthy patients (1.00; 95% CI=0.21-4.82). However, further research is required to support these results. Both apixaban and edoxaban were excluded from statistical analysis due to the lack of clinical studies.
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Affiliation(s)
- C Bensi
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.
| | - S Belli
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - D Paradiso
- S.S.D. of Oral Surgery and Ambulatory, S. Maria della Misericordia Hospital, Perugia, Italy
| | - G Lomurno
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy; S.S.D. of Oral Surgery and Ambulatory, S. Maria della Misericordia Hospital, Perugia, Italy
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