Hemorrhagic Complications and Dental Management of Patients with Anticoagulant Therapy: Case Report.
Main Article Content
Abstract
Introduction: There are different protocols for the management of anticoagulated patients that can be used when performing oral surgical procedures. Objective: To report the previous evaluation and management of a hemorrhagic complication in the maxillofacial region in a patient undergoing oral anticoagulant therapy and the recommendations described in the literature for these patients. Clinical Case: Sixty-eight year old male patient, hospitalized in the cardiology unit due to heart failure, pending surgery for valve replacement. Treating physician requests evaluation for dental infection foci by a maxillofacial surgeon. Prior to medical examination and corresponding blood tests, four carious teeth are extracted, controlling hemostasis with local measures. During the night of the same day, the patient is referred again to the dental unit because of an alveolorrhagia, being treated and controlled with new local measures; new standard blood tests are performed. Forty-eight hours later the patient presents an increase of volume in the right mandibular region compatible with hematoma and ecchymosis. It is decided to perform treatment, removing sutures, collagen and draining through the alveolus. Subsequently, new local measures are performed and the anticoagulant is suspended for 24 hrs. Conclusion: There are different care protocols for patients undergoing anticoagulant treatment in the literature, so each patient should be studied in advance to define what is the best therapeutic procedure to prevent complications.
References
Carrizo A, Carrasco D. Oral surgery in patients under antithrombotic therapy. Narrative review. J Oral Res. 2015; 4(1):58-64.
De Abreu S, Santana T, Machado D, Faria A, de Fatima M, Saquete P. Topical application of tranexamic acid in anticoagulated patients undergoing minor oral surgery: A systematic review and meta-analysis of randomized clinical trials. J CranioMaxilloFac Surg. 2017; 45(1): 20-26.
Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW. Can warfarin be continued during dental extraction? Results of a randomized controlled trial. Br J Oral Maxillofac Surg. 2002; 40(3): 248–252.
Jeske A, Suchko G. Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment. J Am Dent Assoc. 2003; 134(11):1492-1497.
Mauprivez C, Khonsari RH, Razouk O, Goudot P, Lesclous P, Descroix V. Management of dental extraction in patients undergoing anticoagulant oral direct treatment – a pilot study. Oral Surg Oral Med Oral Path Oral Radiol. 2016; 122(5): e146-e155.
Miranda M, Martinez LS, Franco R, Forte V, Barlattani A, Bollero P. Differences between warfarin and new oral anticoagulants in dental clinical practice. Review. Oral Implantol. 2016; 9 (3): 151-156.
Mithiborwala A, Shah N, Mahajan A, Kaur Bagga I, Doshi D, Sanghvi D. Control of Post Extraction Haemorrhage by Tranexamic Acid Pressure Pack in Patients on Anticoagulant and Antiplatelet Therapy: A Prospective Clinical Study. J Craniofac Res. 2016; 1(1): 06–10.
Oake N, Jennings A, Forster AJ, Fergusson D, Doucette S, Walraven CV. Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis. CMAJ. 2008; 179 (3): 235-44.
Pedemonte C, Montini C, Castellón L. Management of Patients in Treatment with Oral Anticoagulants Requiring Oral Surgery. Rev Dent Chile. 2005; 96 (2):18-23.
Quintero E, Sabater MM, Chimenos E, López J. Hemostasia y tratamiento odontológico. Av. Odontoestomatol. 2004; 20 (5): 247-261.
Ripollés de Ramón J, Gómez Font R, Muñoz-Corcuera M, Bascones Martínez A. Actualización en los protocolos de extracción dental en pacientes anticoagulados. Av Odontoestomatol. 2012; 28 (6): 311-320.
Rodríguez-Cabrera MA, Barona-Dorado C, Leco-Berrocal I, Gómez- Moreno G, Martínez-González JM. “Extractions without eliminating anticoagulant treatment: A literature review” Med Oral Patol Oral Cir Bucal. 2011;16 (6):e800-4.
Shi Q, Xu J, Zhang T, Zhang B, Liu H. Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies. Front. Pharmacol. 2017; 8:58. doi: 10.3389/fphar.2017.00058.
Wahl MJ. Myths of dental surgery in patients receiving anticoagulant therapy. J Am Dent Assoc. 2000; 131(1):77-81.
Weltman NJ, Al-Attar Y, Cheung J, Duncan DPB, Katchky A, Azarpazhooh A, Abrahamyan L. Management of Dental Extractions in Patients taking Warfarin as Anticoagulant Treatment: A Systematic Review. J Can Dent Assoc. 2015;81:f20.