Management of Hemorrhage in Surgical and Non-Surgical Dental Procedures

Yıl 2010, Cilt: 4 Sayı: 3, 669 - 674, 01.10.2010

Alper Aktaş Güliz Aktaş

Öz

The management of patients with bleeding disorders depends on the severity of the condition and the invasiveness of the planned dental procedure. These patients have variable risks. The risk of the intervention will depend on the access ibility of the surgical site for local control of hemostasis. Systemic prevention is more important for limited access to the bleeding sites. Local hemostatic techniques must not be used too aggressively during surgery as the resulting tissue damage can prolong healing time. Clinician has to make consultation on mild and severe hemorrhagic disordered patient with patient’s physician. Before managing dental surgery for these patients clinician has to have sufficient knowledge and material for controlling the hemorrhage. Various adjuncts to hemostasis can be employed at the surgical site to enhance hemostasis, aid in vascular closure and prevent clot breakdown. Topical thrombin, topical fibrin glue, absorbable gel atin sponge, oxidized cellulose, microporous polysaccharide hemispheres, fibrin sealant, n-butylcyanoacrylate, tranexamic acid, aminocaproic acid, cauterization, suturing, pressure, splint, Ankaferd Blood Stopper is the adjuncts that are evaluated in this review

Anahtar Kelimeler

Bleeding management, dentistry, postoperative bleeding, coagulopathies management

Dişhekimliğinde Cerrahi ve Cerrahi Olmayan İşlemlerde Kanama Kontrolü: Güncelleme

Öz

Kanama diyatezi bulunan hastalardaki kanama müdahalesi kanama diyatezinin ciddiyetine ve işlemin girişimsel derecesine bağlı olarak değişir. Bu hastalar değişen oranda risk taşırlar. Yapılacak işlemin kanama açısından risk oranı işlem yapılacak bölgenin ulaşılabilirliği ile doğru orantılıdır. Ulaşılabilirliği düşük bölgelerde sistemik olarak uygulanacak kanama kontrol yöntemleri daha önemlidir. Cerrahi sırasında yara iyileşmesini uzatacağı için lokal kanama kontrol yöntemleri agresif olarak uygulanmamalıdır. Dişhekimi orta ve ciddi hemorajik diyatezi bulunan hastalarda, hastanın doktoruyla konsültasyon yapmalıdır. Bu gibi hastalarda dental işleme başlamadan önce kanama kontrolü konusunda yeterli bilgi ve materyale sahip olmalıdır. Cerrahi sahadaki kanamanın durması, damarsal tıkanmanın sağlanması ve pıhtının bozulmasının engellenmesi için birçok işlem yapılabilir. Bu derlemede, topikal trombin, topikal fibrin yapıştırıcı, absorbe olabilen jelatin sünger, okside edilmiş selüloz, mikropöroz polisakkarit, fibrin yapıştırıcı, siyanoakrilat, traneksamik asit, aminokaproik asit, koterizasyon, basınç yöntemi, splint ve Ankaferd Blood Stopper değerlendirilmiştir

Anahtar Kelimeler

Kanama müdahalesi, dişhekimliği, postoperatif kanama, koagülapatilerin müdahalesi

Kaynakça

• Gupta A., Epstein JB., Cabay RJ. Bleeding disorders of importance in dental care and related patient management. JCDA. 73(1):77- 83, 2007.
• Little JW, Falace DA, Miller CS, Rhodus NL. Dental management of the medically compromised patient. 5th ed. St. Louis: CV Mosby Co. 1997 p. 681-742.
• Gomez-Moreno G., Cutando-Soriano A, Arana C, Scully C. Hereditary blood coagulation disorders: management and dental treatment. J Dent Res. 84(11):978-985, 2005.
• Israels S., Schwetz N., Boyar R., McNicol A. Bleeding disorders: Characterization, dental consideration and management. J Can Dent Assoc. 72(9): 827. 2006.
• Kumar JN, Kumar RA, Varadarajan R, Sharma N. Specialty dentistry for the hemophiliac: is there a protocol in place? Indian J Dent Res. 18(2):48-54, 2007.
• Shetty V., Bertolami CN. Wound Healing In. Miloro M. ed. Peterson’s Princinles of oral and Maxillofacial Surgery. 2nd ed. Hamilton London 2004. p. 10.
• Mitchell R. An evaluation of bone healing in cavities in the jaws implanted with a collagen matrix. Br J Oral Maxillofac Surg. 30(3);180-2, 1992.
• Mattsson T., Anderssen K., Koendell PA., Lindskog S. A longitudinal comparative histometric study of the biocompability of threee local hemostatic agents. Int J Oral Maxillofac Surg. 19(1);47-50, 1990.
• Marjanovic M. Use of thrombin powder after tooth extraction in patients receiving anticoagulant therapy. Vojnosanit Pregl. 59(4):389-392, 2002.
• Kovacs B, Tóth K, Kerenyi GPost-extraction hemostasis during coumarin anticoagulant therapy with a locally applied coagulation-active substance. Int J Oral Surg. 5(1):3-7, 1976.
• Rackoz M, Mazar A, Varon D, Spierer S, Blinder D, Martinowitz U. Dental extractions in patients with bleeding disorders. The use of fibrin glue. Oral Surg Oral Med Oral Pathol. 75(3):280– 282, 1993.
• Martinowitz U, Schulman S, Horoszowski H, Heim M. Role of fibrin sealants in surgical procedures on patients with hemostatic disorders. Clin Orthop Relat Res. 328(2):65–75, 1996.
• Filho Ade M, dos Santos RS, Costa JR, Puppin AA, de Rezende RA, Beltrão GC. Oral surgery with fibrin sealants in patients with bleeding disorders: a case report. J Contemp Dent Pract. 7(3):106-112, 2006.
• Abada HT, Golzarian J. Gelatine sponge particles: handling characteristics for endovascular use. Tech Vasc Interv Radiol. 10(4):257-260, 2007.
• Blinder D, Manor Y, Martinowitz U, Taicher S. Dental extractions in pa tients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding. Int J Oral Maxillofac Surg. 30(6):518–521, 2001.
• Blinder D, Manor Y, Martinowitz U, Taicher S, Hashomer T. Dental extractions in patients maintained on continued oral anticoagulant: comparison of local hemostatic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 88(2):137-140, 1999.
• Kollár P, Suchý P, Muselík J, Bajerová M, Havelka P, Sopuch T. Hemostatic effects of oxidized cellulose Ceska Slov Farm. 57(1):11-16, 2008.
• Petersen JK, Krogsgaard J, Nielsen KM, Nİrgaard EB. A comparison between 2 absorbable hemostatic agents: gelatin sponge (Spongostan) and oxidized regenerated cellulose (Surgicel). Int J Oral Surg. 13(5):406-410, 1984.
• Biondo-Simões Mde L, Petrauskas R, Dobrowolski AG, Godoy G, Kaiber F, Ioshii SO. Validity of microporous polysaccharide hemispheres as a hemostatic agent in hepatic injuries: an experimental study in rats. Acta Cir Bras. 22(1):29-33, 2007.
• Zusman SP, Lustig JP, Baston I. Postextraction hemostasis in patients on anticoagulant therapy: the use of a fibrin sealant. Quintessence Int. 23(10):713–716, 1992.
• Davis BR, Sándor GK. Use of fibrin glue in maxillofacial surgery. J Otolaryngol. 27(2):107- 112, 1998.
• Spotnitz WD, Prabhu R. Fibrin sealant tissue adhesive-review and update. J Long Term Eff Med Implants. 15(3):245-270, 2005.
• Al-Belasy FA, Amer MZ. Hemostatic effect of n-butyl-2-cyanoacrylate (histoacryl) glue in warfarin-treated patients undergoing oral surgery. J Oral Maxillofac Surg. 61(12):1405- 1409, 2003.
• Kulkarni SS, Chava VK. Comparison of cyanoacrylate and silk sutures on healing of oral wounds--an animal model study. Indian J Dent Res. 14(4):254-258, 2003.
• Mannucci PM. Hemostatic drugs. N Engl J Med. 339(4):245–253, 1998.
• Sindet-Pedersen S, Stenbjerg S. Effect of local antifibrinolytic treat ment with tranexamic acid in hemophiliacs undergoing oral surgery. J Oral Maxillofac Surg. 44(9):703–707,1986.
• Sindet-Pedersen S, Ramstrom G, Bernvil S, Blomback M. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients under going oral surgery. N Engl J Med. 320(12):840–843,1989.
• Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 57(6):1005-1032,1999.
• Björlin G, Nilsson IM. The effect of antifibrinolytic agents on wound healing. Int J Oral Maxillofac Surg, 17(4):275-276,1988.
• Wellington K, Wagstaff AJ. Tranexamic acid: a review of its use in the management of menorrhagia. Drugs. 63(13):1417-1433,2003.
• Lucas ON, Albert TW. Epsilon aminocaproic acid in hemophiliacs undergoing dental extractions: a concise review. Oral Surg Oral Med Oral Pathol. 51(2):115-120,1981.
• Gardner FH, Helmer RE 3rd. Aminocaproic acid. Use in control of hemorrhage in patients with amegakaryocytic thrombocytopenia. JAMA. 243(1):35-37,1980.
• Ziccardi VB, Saini J, Demas PN, Braun TW. Management of the oral and maxillofacial surgery patient with end-stage renal disease. J Oral Maxillofac Surg. 50(11):1207–1212,1992.
• Lockhart PB, Gibson J, Pond SH, Leitch J. Dental management considera tions for the patient with an acquired coagulopathy. Part 2: Coagulopathies from drugs. Br Dent J. 195(9):495–401,2003.
• Lockhart PB, Gibson J, Pond SH, Leitch J. Dental management considera tions for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease. Br Dent J. 195(8):439–445,2003.
• Ness Gm, Peterson JL. Impacted Teeth In: Miloro M. ed. Peterson’s Principles of oral and Maxillofacial Surgery 2nd ed Hamilton London. 2004: p.150.
• Kaddour Brahim A, Stieltjes N, Roussel-Robert V, Yung F, Ginisty D. Dental extractions in children with congenital coagulation disorders: therapeutic protocol and results. Rev Stomatol Chir Maxillofac. 107(5):331-337,2006.
• Adornato MC, Penna KJ. Hemostatic technique. Using a splint in oral bleeding. N Y State Dent J. 67(6):24-25,2001.
• Goker H, Haznedaroglu IC, Ercetin S, Kirazli S, Akman U, Ozturk Y, et al. Hemostatic actions of the folkloric medicinal plant extract Ankaferd Blood Stopper. J Int Med Res. 36(1):163- 170,2008.
• Cipil H, Kosar A, Kaya A, Uz B, Haznedaroglu IC, Goker H, et al. In Vivo Hemostatic Effect of the Medicinal Plant Extract Ankaferd Blood Stopper in Rats Pretreated With Warfarin. Clin Appl Thromb Hemost.15(3):270-276,2009.
• Bilgili H, Kosar A, Kurt M, Onal IK, Goker H, Captug O, et al. Hemostatic efficacy of Ankaferd Blood Stopper in a swine bleeding model.Med Princ Pract. 18(3):165-169,2009.
• Ibis M, Kurt M, Onal IK, Haznedaroglu IC. Successful management of bleeding due to solitary rectal ulcer via topical application of Ankaferd blood stopper. J Altern Complement Med. 14(9):1073-1074,2008.
• Kurt M, Kacar S, Onal IK, Akdogan M, Haznedaroglu IC. Ankaferd Blood Stopper as an effective adjunctive hemostatic agent for the management of life-threatening arterial bleeding of the digestive tract. Endoscopy 40(2):E262,2008.
• Kurt M, Disibeyaz S, Akdogan M, Sasmaz N, Aksu S, Haznedaroglu IC. Endoscopic application of ankaferd blood stopper as a novel experimental treatment modality for upper gastrointestinal bleeding: a case report. Am J Gastroenterol. 103(8):2156-2158,2008.
• Akkoc N., Akcelik M., Haznedaroglu IC., Göker H., Turgut M., Aksu S., Kirazlı S., Fırat HC. In vitro anti-bacterial activities of Ankaferd medicinal plant extract.Turk Klinik J Med Sci. 29(2):410-415,2009.