Evaluation of bleeding risk and measurement methods in dental patients

Resident: Cho
Author(s): Canigral et al.
Journal: Med Oral Patol Oral Cir Bucal
Year. Volume (number). Page #’s: 2010. 15. 863-8.
Major topic: Bleeding risk, antithrombotic treatment, antiplatelet drugs, extractions
Type of Article: Scientific Article

Main Purpose: The purpose of this study was to explore bleeding manifestations in dental surgical procedures, evaluate the influence of antithrombotic drugs upon bleeding risk, and validate the efficiency of a clinical method for the measurement of bleeding after dental extraction or surgery.

Overview of method of research:
Prospective observational study of 99 patients taking antithrombotic medications seen in the Stomatology Units of Dr. Peset University Hospital (Spain) and Castellon General Hospital (Spain). Patients scheduled for simple tooth extraction had no modification of antiplatelet medication. Simple extraction only carried out if INR proved compatible with the surgery. Patients scheduled for complex procedures (multiple extractions, impacted dental surgery, biopsies) or combined antiplatelet treatment were referred to the Service of Hematology to plan the management approach.
On the first visit, clinical history was compiled and blood tests requested, including a complete blood count, Quick index, INR, aPPT, fibrinogen and platelet function tests (TRAP test, ASPI test, ADP test, ADPHS test). For data collection, a form was developed documenting different demographic parameters, medical history, acquired and congenital bleeding risk factors, simple or complete procedure, bleeding manifestations, complications, and range of laboratory test data. Three levels of bleeding intensity after dental surgery were defined: MILD (subsides in under 10 minutes with sterile gauze tamponade), MODERATE (subsides with tamponade plus local hemostatic treatment in under 60 minutes), and SEVERE (bleeding for over 60 minutes and requiring other medical or surgical management).

Findings:
The age of the patients ranged form 15-93, with mean age of 58. Most common problems in medical history included cardiovascular diseases, arterial hypertension, diabetes, renal failure, neoplastic processes, and thromboembolic complications. Mean number of drugs per patient was 3. Patients were taking a range of antithrombotic medications including aspirin, plavix, combination of aspirin and plavix, oral anticoagulants, LMWH, and NSAIDs.
Most of the bleeding manifestations were mild (92%). 8% had moderate bleeding episodes, which correlated to the ASPI platelet function test and advanced patient age. No significant correlation was found between the complexity of the procedure and bleeding risk.
In conclusion, the results of this study suggest the incorporation of the new platelet function tests to the preoperative workup of certain complex dental patients may increase safety of surgical procedures.

Assessment of Article: Good article. Pertains more to elderly patients but good to review.