Dentoalveolar Procedures in Immune Thrombocytopenia; Systematic Review and an Institutional Guideline

Abstract

Background Dentoalveolar procedures in immune thrombocytopenia (ITP) pose a risk of bleeding, due to thrombocytopenia, and infection, due to immunosuppressive treatments. We aimed to systematically review the safety and management of dentoalveolar procedures in ITP patients in order to create practical recommendations. Methods Pubmed, Embase, Cochrane and Cinahl were searched for original studies on dentoalveolar procedures in known primary ITP patients. We recorded bleeding- and infection-related outcomes and therapeutic strategies. Clinically relevant bleeding was defined as needing medical attention. Results Seventeen articles were included, of which twelve case reports/series. Overall, the quality of the available evidence was poor. Outcomes and administered therapies (including hemostatic therapies and prophylactic antibiotics) were not systematically reported. At least 73 dentoalveolar procedures in 49 ITP patients were described. The range of preoperative platelet count was 2-412*109/L. Two clinically relevant bleedings (2%) were reported in the same patient, of which one was life-threatening. Strategies used to minimalize the risk of bleeding were heterogeneous and included therapies to increase platelet count, antifibrinolytics, local measures and minimally invasive techniques. Reports on the occurrence of bleedings due to anesthetics or infection were lacking. Conclusion Based on alarmingly limited data, clinically relevant bleedings and infections after dentoalveolar procedures in ITP patients seem rare. Awaiting prospective and controlled studies to further evaluate these risks and the efficacy of therapeutic interventions, we provided our institutional guideline to guide the management of dentoalveolar procedures in ITP patients.