Minor oral surgical procedures in patients on anticoagulant therapy

Yıl 2011, Cilt: 2011 Sayı: 4, 1 - 8, 01.04.2011

Yrd. Doç. Dr. Göksel Şimşek Kaya Prof. Dr. Ertunç Dayı Arş. Gör. Dt. Günay Yapıcı

Öz

-

Anahtar Kelimeler

-

Antikoagülan tedavisi gören hastalarda minör oral cerrahi prosedürler

Öz

Antikoagülan ilaçlar arterial ve venöz tromboembolizmin profilaksisinde ve tedavisinde yaygın olarak kullanılmaktadır. Bu ilaçların kullanımı hem aşırı antikoagülasyon hem de yetersiz antitrombotik etkiyle ilişkili olan yan etkilerin minimalize edilirken, istenilen teröpatik etkinin sağlanabilmesi için doğru monitörizasyonu ve doz ayarlamasını gerektirir. Bu durumun sağlanması özellikle hastalar diş çekimi gibi cerrahi girişime maruz kaldıkları zaman önemlidir. Sunduğumuz çalışmada antikoagülan kullanan hastaların minör oral cerrahi ile ilgili tedavisine yönelik bilimsel öneriler gözden geçirilmiştir. Son yıllarda yapılan birçok çalışma basit diş çekimi gibi minör oral cerrahi girişimlerden önce international normalized ration (INR)'nin teröpatik aralıkta olması sağlandığı ve hemostaz için lokal önlemler alındığı müddetçe antikoagülan tedavisinin azaltılmamasını, ara verilmemesini veya heparin tedavisiyle değiştirilmemesini tavsiye etmektedir. Antikoagülasyon tedavisinde uygulanacak olan herhangi bir değişiklik, hastanın tedavisini yapan doktorla birlikte karar vererek gerçekleştirilmelidir

Anahtar Kelimeler

Antikoagülan ilaç, oral cerrahi, intraoperatif kanama postoperatif kanama

Kaynakça

• Plaza-Costa A, Garcia-Romero P, Poveda-Roda R, Bagan JV, Silvestre-Donat FJ, Cervero JA. A comparative study between INR and the determination of prothrombin time with the Coaguchek (r) portable coagulometer in the dental treatment of anticoagulated patients. Med Oral 2002; 7 (2): 130–5.
• Scully C, Wolff A. Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94 (1): 57–64.
• Cannon PD, Dharmar VT. Minor oral surgical procedures in patients on oral anticoagulants--a controlled study. Aust Dent J 2003; 48 (2): 115–8.
• Dunn AS, Turpie AG. Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med 2003; 163 (8): 901–8.
• Troulis MJ, Head TW, Leclerc JR. Dental extractions in patients on an oral anticoagulant: a survey of practices in North America. J Oral Maxillofac Surg 1998; 56 (8): 914–7.
• Çil BE, Türkbey B, Canyigit M, Geyik S, Yavuz K. Karotis stentlemenin nadir bir komplikasyonu: spontan rektus kilif hematomu ve endovasküler tedavisi Diagn Interv Radiol 2007; 13: 46–48.
• Beirne OR. Evidence to continue oral anticoagulant therapy for ambulatory oral surgery. J Oral Maxillofac Surg 2005; 63 (4): 540–5.
• 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 1999; 88 (2): 137–40.
• Al-Belasy FA, Amer MZ. Hemostatic effect of nbutyl-2-cyanoacrylate (histoacryl) glue in warfarin-treated patients undergoing oral surgery. J Oral Maxillofac Surg 2003; 61 (12): 1405–9.
• Blinder D, Manor Y, Martinowitz U, Taicher S. Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding. Int J Oral Maxillofac Surg 2001; 30 (6): 518–21.
• Aframian DJ, Lalla RV, Peterson DE. Management of dental patients taking common hemostasisaltering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103 (suppl): E1–11.
• Jeske AH, Suchko GD. Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment. J Am Dent Assoc 2003; 134 (11): 1492–7.
• Todd DW, Roman A. Outpatient use of lowmolecular weight heparin in an anticoagulated patient requiring oral surgery: case report. J Oral Maxillofac Surg 2001; 59 (9): 1090–2.
• Mehra P, Cottrell DA, Bestgen SC, Booth DF. Management of heparin therapy in the high-risk, chronically anticoagulated, oral surgery patient: a review and a proposed nomogram. J Oral Maxillofac Surg 2000; 58 (2): 198–202.
• Johnson-Leong C, Rada RE. The use of lowmolecular-weight heparins in outpatient oral surgery for patients receiving anticoagulation therapy. J Am Dent Assoc 2002; 133 (8): 1083–7.
• Pavek V, Bigl P. Stomatological treatment of patients with artificial heart valves: coagulation control and antibiotic cover. Int Dent J 1993; 43 (1): 59–61
• Zanon E, Martinelli F, Bacci C, Cordioli G, Girolami A. Safety of dental extraction among consecutive patients on oral anticoagulant treatment managed using a specific dental management protocol. Blood Coagul Fibrinolysis 2003; 14 (1): 27–30.
• Halfpenny W, Fraser JS, Adlam DM. Comparison of 2 hemostatic agents for the prevention of postextraction hemorrhage in patients on anticoagulants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92 (3): 257–9.
• Askey JM, Cherry CB. Dental extraction during dicumarol therapy. Calif Med 1956; 84 (1): 16–17.
• Sacco R, Sacco M, Carpenedo M, Mannucci PM. Oral surgery in patients on oral anticoagulant therapy: a randomized comparison of different intensity targets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104 (1): E18–21.
• Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med 1998;158 (15): 1610–6.
• Pototski M, Amenábar JM. Dental management of patients receiving anticoagulation or antiplatelet treatment. J Oral Sci 2007; 49 (4): 253–8.
• Bodner L, Weinstein JM, Baumgarten AK. Efficacy of fibrin sealant in patients on various levels of oral anticoagulant undergoing oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86 (4): 421–4.
• Jiménez Y, Poveda R, Gavaldá C, Margaix M, Sarrión G. An update on the management of anticoagulated patients programmed for dental extractions and surgery. Med Oral Patol Oral Cir Bucal 2008; 13 (3): E176–9.
• 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): 248–52.
• Della Valle A, Sammartino G, Marenzi G, Tia M, Espedito di Lauro A, Ferrari F, Lo Muzio L. Prevention of postoperative bleeding in anticoagulated patients undergoing oral surgery: use of platelet-rich plasma gel. J Oral Maxillofac Surg 2003; 61(11): 1275–8.
• Campbell JH, Alvarado F, Murray RA. Anticoagulation and minor oral surgery: should the anticoagulation regimen be altered? J Oral Maxillofac Surg 2000; 58 (2): 131–5.
• Uras F, Uras AR. Protrombinin dünü-bugünü. IV. Ulusal Tromboz, Hemostaz ve Anjioloji Kongresi Kitabi, May Matbaacilik Ltd; Istanbul: 2003. p. 85–95.
• Salam S, Yusuf H, Milosevic A. Bleeding after dental extractions in patients taking warfarin. Br J Oral Maxillofac Surg 2007; 45 (6): 463–6.
• Perry DJ, Noakes TJ, Helliwell PS. British Dental Society. Guidelines for the management of patients on oral anticoagulants requiring dental surgery. Br Dent J 2007; 13; 203 (7): 389–93.
• Linhardt RJ, Günay NS. Production and chemical processing of low molecular weight heparins. Semin Thromb Hemost 1999; 25 (3): 5–16
• Weitz J. Low-molecular weight heparins. N Eng J Med 1997; 337 (10): 688–99.
• Hirsh J, Raschke R. Heparin and lowmolecularweight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic therapy. Chest 2004; 126 (suppl 3): 188–203.
• Büller HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE. Antithrombotic therapy for venous thromboembolic disease. The Seventh ACCP Conference on Antithrombotic and Thrombolytic therapy. Chest 2004; 126 (suppl 3): 401- 428.
• Kearon C, Johnston M, Moffat K, McGinnis J, Ginsberg JS. Effect of warfarin on activated partial thromboplastin time in patients receiving heparin Arch Intern Med 1998; 158 (10):1140–1143.
• Hull RD, Pineo GF. Current concepts of anticoagulation therapy. Clinics in Chest Medicine 1995; 16 (2): 269–280.
• Task Force Report. Guidelines on diagnosis and management of acute pulmonary embolism. European Heart Journal 2000; 21: 1301–1336.
• Fareed J, Jeske W, Hoppensteadt D, Clarizio R, Walenga JM. Are the available low-molecularweight heparin preparations the same? Semin Thromb Hemost 1996; 22 (Suppl 1): 77–91.
• European Pharmacopeia Commision. Pharmeuropea 1991; 3: 161–165.
• Badak MI, Kurtoglu T, Özkisacik EA, Boga M, Gürcün U, Sirek N, Köseoglu K, Disçigil B. Derin ven trombozunda standart heparin tedavisi sonuçlarimiz ADÜ Tip Fakültesi Dergisi 2005; 6 (2): 19 – 22.
• Bloomer CR. Excessive hemorrhage after dental extractions using low-molecular-weight heparin (Lovenox) anticoagulation therapy. J Oral Maxillofac Surg 2004;62 (1): 101–3.
• Webster K, Wilde J. Management of anticoagulation in patients with prosthetic heart valves undergoing oral and maxillofacial operations. Br J Oral Maxillofac Surg 2000; 38(2): 124–6.
• Carter G, Goss A, Lloyd J, Tocchetti R. Tranexamic acid mouthwash versus autologous fibrin glue in patients taking warfarin undergoing dental extractions: a randomized prospective clinical study. J Oral Maxillofac Surg. 2003; 61 (12): 1432–5.
• Morimoto Y, Niwa H, Minematsu K. Hemostatic management of tooth extractions in patients on oral antithrombotic therapy. J Oral Maxillofac Surg 2008; 66 (1): 51–7.