Unbound MEDLINE

Postoperative bleeding after dental extraction in liver pretransplant patients.

Abstract

PURPOSE
The aim of this prospective observational study was to evaluate the incidence of postoperative bleeding after dental extraction in candidates for liver transplantation and the efficacy of the association of tranexamic acid and absorbable hemostatic sponges.
PATIENTS AND METHODS
All individuals referred for oral health evaluation requiring extraction were considered in this study. Patients were included in the analysis when the blood examinations showed a platelet count of 30,000/mm(3) or greater and an international normalized ratio (INR) of 3.0 or less. In group 1 local pressure was applied by use of gauze soaked with tranexamic acid, and in group 2 gauze without tranexamic acid was used. Absorbable hemostatic sponges and cross sutures were used as a standard hemostatic measure.
RESULTS
In the 23 patients included in this study, 84 simple extractions were performed during 35 dental surgical procedures. The main preoperative blood tests found the following: a mean hematocrit level of 34.54% (SD, 5.84%; range, 21.7%-44.4%), platelet counts from 31,000/mm(3) to 160,000/mm(3), and a mean INR of 1.50 (SD, 0.39; range, 0.98-2.59). Postoperative bleeding occurred during only 1 procedure (2.9%), and local pressure with gauze was effective for achieving hemostasis. No statistically significant difference in the time to hemostasis was found between the 2 groups.
CONCLUSIONS
This study found a low risk of bleeding for tooth extractions in patients with liver cirrhosis, INRs of 2.50 or less, and platelet counts of 30,000/mm(3) or greater. Blood transfusions were not needed, and in the case of postoperative bleeding, the use of local hemostatic measures was satisfactory.

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  • Publisher Full Text
  • Authors

    Perdigão JP, de Almeida PC, Rocha TD, Mota MR, Soares EC, Alves AP, Sousa FB

    Source

    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 70:3 2012 Mar pg e177-84

    MeSH

    Adult
    Antifibrinolytic Agents
    Cross-Sectional Studies
    Dental Care for Chronically Ill
    Female
    Hemostatic Techniques
    Humans
    International Normalized Ratio
    Liver Cirrhosis
    Liver Transplantation
    Male
    Middle Aged
    Oral Hemorrhage
    Platelet Count
    Postoperative Hemorrhage
    Preoperative Care
    Pressure
    Prospective Studies
    Tooth Extraction
    Tranexamic Acid
    Treatment Outcome
    Young Adult

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    22374059