Oral antikoagülan kullanan atriyal fibrilasyon hastalarında spontan dişeti kanaması ve ilişkili ilaç bırakma sıklığının değerlendirilmesi: vaka kontrollü çalışma
Year 2021,
Volume: 46 Issue: 1, 325 - 331, 31.03.2021
Amaç: Bu çalışmanın amacı, oral antikoagülan (OAK) kullanan atriyal fibrilasyon (AF) hastalarında spontan dişeti kanaması (SDK) ve buna bağlı ilaç bırakma sıklığının değerlendirilmesidir.
Gereç ve Yöntem: OAK ilaç kullanan 457 AF hastası taranarak spontan dişeti kanaması olan 32 hasta tespit edildi. Bu hastalar, spontan dişeti kanaması olmayan 32 AF hastası ile yaş, cinsiyet ve OAK tedavi protokolü açısından eşleştirilerek periodontal parametreleri karşılaştırıldı.
Bulgular: Çalışmaya dahil edilen total popülasyonda, 32 hastada (32/457; % 7.0) SDK saptandı ve bu hastaların 13'ünde (% 40.6) kanamaya bağlı OAK ilaç kullanımını bıraktığı tespit edildi. Plak indeksi (PI), gingival indeks (GI) ve cep derinlikleri (CD) SDK olan hastalarda anlamlı olarak daha yüksek bulundu. Gingival indeksin, hastaların OAK ilacı bırakma riskini bağımsız olarak etkilediği tespit edildi.
Sonuç: OAK tedavisi altındaki AF hastalarında, önceden var olan periodontal hastalık nedeniyle önemli oranda SDK ve buna bağlı hastanın OAK ilaç kullanımını bıraktığı gözlendi. Ayrıca gingival indeks skorları, SDK ve OAK ilacın bırakılmasında risk indikatörüdür. OAK tedavisinden önce hastaların periodontal muayenesi ve / veya tedavisi yapılması önerilir.
Muhlemann H: Gingival sulcus bleeding-a leading symptom in initial gingivitis. Helv Odontol Acta. 1971;15:107-13.
Weinberg MA, Hassan H: Bleeding on probing: what does it mean? Gen Dent. 2012;60:271-6
Bondon‐Guitton E, Mourgues T, Rousseau V, Cousty S, Cottin J, Drablier G, Micallef J, Montastruc JL: Gingival bleeding, a possible “serious” adverse drug reaction: An observational study in the French PharmacoVigilance Database. J Clin Periodontol. 2017;44:898-904.
Tack DA, Rogers III RS: Oral drug reactions. Dermatol Ther. 2002;15:236-50.
Little JW, Little JW. Dental management of the medically compromised patient. Elsevier Mosby, 2008.
Hughes M, Lip G: Risk factors for anticoagulation-related bleeding complications in patients with atrial fibrillation: a systematic review. QJM: Int J Med. 2007;100:599-607.
Wyndham CR. Atrial fibrillation: the most common arrhythmia. Tex Heart Inst J. 2000;27:257-267.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener H-C, Heidbuchel H, Hendriks JJEjoc-ts: 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50(5):e1-e88.
Wu L, Chang Q, Wang T, Zhang Z, Lou Y. Clinical observation of postoperative warfarin anticoagulation in 300 patients undergoing mitral valve replacement with a carbomedics mechanical valve. Heart Surg Forum. 2015;18:E063-E066.
Löe H, Silness J: Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand. 1963;21:533-51.
Silness J, Löe H: Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121-35.
Armitage GC: Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4:1-6.
Farina R, Scapoli C, Carrieri A, Guarnelli ME, Trombelli L: Prevalence of bleeding on probing: a cohort study in a specialist periodontal clinic. Quintessence Int. 2011;42.
Trombelli L, Farina R, Silva CO, Tatakis DN: Plaque‐induced gingivitis: Case definition and diagnostic considerations. J Clin Periodontol. 2018;45:S44-S67.
Werth S, Breslin T, NiAinle F, Beyer-Westendorf J: Bleeding risk, management and outcome in patients receiving non-VKA oral anticoagulants (NOACs). Am. J. Cardiovasc. Drugs 2015;15:235-42.
Aarabi G, Schnabel RB, Heydecke G, Seedorf U: Potential impact of oral inflammations on cardiac functions and atrial fibrillation. Biomolecules 2018;8:66.
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J: Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51.
Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A: Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-92.
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP: Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-91.
Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, Waldo AL, Ezekowitz MD, Weitz JI, Špinar J: Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093-104.
Zhang Q, Qin Y, Zhao D-s, Zhao H-p, Zhou L: Prognostic value of red blood cell distribution width on bleeding events in nonvalvular atrial fibrillation patients taking dabigatran (110 mg bid) after catheter ablation. Cardiology 2017;136:215-21.
Vanga SR, Satti SR, Williams J, Weintraub W, Doorey A: Discontinuation of oral anticoagulation preceding acute ischemic stroke–prevalence and outcomes: Comprehensive chart review. Postgrad Med. 2015;127:791-95.
Albandar J, Kingman A: Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988‐1994. J Periodontol 1999;70:30-43.
Dhir S, Wangnoo S, Kumar V: Impact of glycemic levels in Type 2 diabetes on periodontitis. Indian J Endocrinol Metab. 2018;22:672.
Nair P, Sutherland G, Palmer R, Wilson R, Scott D: Gingival bleeding on probing increases after quitting smoking. J Clin Periodontol. 2003;30:435-37.
Ollikainen E, Saxlin T, Tervonen T, Suominen AL, Knuuttila M, Jula A, Ylöstalo P: Association between periodontal condition and hypertension in a non‐smoking population aged 30–49 years: results of the Health 2000 Survey in Finland. J Clin Periodontol. 2014;41:1132-38.
Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FKJC: Bacteremia associated with tooth brushing and dental extraction. Circulation. 2008;17:3118-25.
Evaluation of spontaneous gingival bleeding and related drug withdrawal frequency in atrial fibrillation patients using oral anticoagulants: a case-controlled study
Year 2021,
Volume: 46 Issue: 1, 325 - 331, 31.03.2021
Purpose: The aim of this study was to investigate the frequency of gingival bleeding (GB) and associated drug-withdrawal in atrial fibrillation (AF) patients using oral anti-coagulants (OAC).
Materials and Methods: 457 patients with AF receiving OAC were screened. The periodontal parameters and OAC drug-withdrawal of 32 patients with spontaneous GB were compared with 32 patients without bleeding who were matched for age, sex and OAC treatment protocol.
Results: GB was detected in 32 patients (7.0%) and 13 of these patients (40.6%) had OAC drug-withdrawal due to bleeding. The plaque index (PI), gingival index (GI) and probing pocket depths (PPD) were significantly higher in patients with GB. The GI scores independently determined the risk of OAC drug-withdrawal.
Conclusion: AF patients under OAC treatment may have significant rates of GB and subsequent OAC withdrawal due to pre-existing periodontal disease. The GI scores and GB can predict the risk of OAC drug-withdrawal. The periodontal examination and/or treatment of these patients should be performed before OAC treatment.
Muhlemann H: Gingival sulcus bleeding-a leading symptom in initial gingivitis. Helv Odontol Acta. 1971;15:107-13.
Weinberg MA, Hassan H: Bleeding on probing: what does it mean? Gen Dent. 2012;60:271-6
Bondon‐Guitton E, Mourgues T, Rousseau V, Cousty S, Cottin J, Drablier G, Micallef J, Montastruc JL: Gingival bleeding, a possible “serious” adverse drug reaction: An observational study in the French PharmacoVigilance Database. J Clin Periodontol. 2017;44:898-904.
Tack DA, Rogers III RS: Oral drug reactions. Dermatol Ther. 2002;15:236-50.
Little JW, Little JW. Dental management of the medically compromised patient. Elsevier Mosby, 2008.
Hughes M, Lip G: Risk factors for anticoagulation-related bleeding complications in patients with atrial fibrillation: a systematic review. QJM: Int J Med. 2007;100:599-607.
Wyndham CR. Atrial fibrillation: the most common arrhythmia. Tex Heart Inst J. 2000;27:257-267.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener H-C, Heidbuchel H, Hendriks JJEjoc-ts: 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50(5):e1-e88.
Wu L, Chang Q, Wang T, Zhang Z, Lou Y. Clinical observation of postoperative warfarin anticoagulation in 300 patients undergoing mitral valve replacement with a carbomedics mechanical valve. Heart Surg Forum. 2015;18:E063-E066.
Löe H, Silness J: Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand. 1963;21:533-51.
Silness J, Löe H: Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121-35.
Armitage GC: Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4:1-6.
Farina R, Scapoli C, Carrieri A, Guarnelli ME, Trombelli L: Prevalence of bleeding on probing: a cohort study in a specialist periodontal clinic. Quintessence Int. 2011;42.
Trombelli L, Farina R, Silva CO, Tatakis DN: Plaque‐induced gingivitis: Case definition and diagnostic considerations. J Clin Periodontol. 2018;45:S44-S67.
Werth S, Breslin T, NiAinle F, Beyer-Westendorf J: Bleeding risk, management and outcome in patients receiving non-VKA oral anticoagulants (NOACs). Am. J. Cardiovasc. Drugs 2015;15:235-42.
Aarabi G, Schnabel RB, Heydecke G, Seedorf U: Potential impact of oral inflammations on cardiac functions and atrial fibrillation. Biomolecules 2018;8:66.
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J: Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51.
Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A: Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-92.
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP: Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-91.
Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, Waldo AL, Ezekowitz MD, Weitz JI, Špinar J: Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093-104.
Zhang Q, Qin Y, Zhao D-s, Zhao H-p, Zhou L: Prognostic value of red blood cell distribution width on bleeding events in nonvalvular atrial fibrillation patients taking dabigatran (110 mg bid) after catheter ablation. Cardiology 2017;136:215-21.
Vanga SR, Satti SR, Williams J, Weintraub W, Doorey A: Discontinuation of oral anticoagulation preceding acute ischemic stroke–prevalence and outcomes: Comprehensive chart review. Postgrad Med. 2015;127:791-95.
Albandar J, Kingman A: Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988‐1994. J Periodontol 1999;70:30-43.
Dhir S, Wangnoo S, Kumar V: Impact of glycemic levels in Type 2 diabetes on periodontitis. Indian J Endocrinol Metab. 2018;22:672.
Nair P, Sutherland G, Palmer R, Wilson R, Scott D: Gingival bleeding on probing increases after quitting smoking. J Clin Periodontol. 2003;30:435-37.
Ollikainen E, Saxlin T, Tervonen T, Suominen AL, Knuuttila M, Jula A, Ylöstalo P: Association between periodontal condition and hypertension in a non‐smoking population aged 30–49 years: results of the Health 2000 Survey in Finland. J Clin Periodontol. 2014;41:1132-38.
Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FKJC: Bacteremia associated with tooth brushing and dental extraction. Circulation. 2008;17:3118-25.
Özcan, Mustafa and Hasan Koca. “Evaluation of Spontaneous Gingival Bleeding and Related Drug Withdrawal Frequency in Atrial Fibrillation Patients Using Oral Anticoagulants: A Case-Controlled Study”. Cukurova Medical Journal, vol. 46, no. 1, 2021, pp. 325-31, doi:10.17826/cumj.803059.