World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review

Karasneh, Jumana; Christoforou, Janina; Walker, Jennifer; Manfrēdi, M.; Dave, Bella; Dios, Pedro Diz; Lockhart, Peter B.; Patton, Lauren L.

doi:10.1111/odi.13082

Cited by 14 publications

(17 citation statements)

References 31 publications

(73 reference statements)

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“…A systematic review on platelet counts and hemorrhagic complications following invasive dental procedures reported that platelet counts must be at least 50k before a surgical procedure, prophylactic platelet transfusions do not reduce the risk of postoperative hemorrhagic complications, and that local treatment on the extraction wound is important for reducing postoperative bleeding 4 . In our study, 18 (13.8%) of the 130 patients who underwent tooth extractions with thrombocytopenia had received a platelet transfusion before tooth extraction, and one of these patients experienced a hemorrhagic complication.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is necessary to predict the risk of bleeding through an evaluation of the extraction site and choose an appropriate treatment approach for bleeding control. Studies have reported that an appropriate evaluation of the hemorrhagic nature of the tooth extraction site is necessary for patients with thrombocytopenia to reduce post-extraction bleeding 4 , 5 , 12 . In addition, high levels of experience and care of the surgeon are required for preventing postoperative hemorrhagic complications 4 , 5 , 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Studies have reported that an appropriate evaluation of the hemorrhagic nature of the tooth extraction site is necessary for patients with thrombocytopenia to reduce post-extraction bleeding 4 , 5 , 12 . In addition, high levels of experience and care of the surgeon are required for preventing postoperative hemorrhagic complications 4 , 5 , 12 .…”

Section: Discussionmentioning

confidence: 99%

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The incidence of postoperative hemorrhage after tooth extraction in patients with thrombocytopenia

Kang

2021

JKAOMS

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Objectives The risk of bleeding after tooth extraction in thrombocytopenia patients remains unclear. Therefore, the present study aimed to assess the risk of bleeding after tooth extraction in patients with thrombocytopenia. Materials and Methods The study included 220 patients who had a medical history of thrombocytopenia and underwent tooth extraction (330 teeth). The patients were divided into those who had thrombocytopenia (platelet count <150k) immediately before the tooth extraction, and those who had platelet counts that were between 150k and 250k before the extraction. Bleeding complications were recorded and compared between the patient groups. Results Of the 220 patients, 130 underwent tooth extractions while having thrombocytopenia (platelet count <150k), and 90 had platelet counts that were between 150k and 250k before tooth extractions. Bleeding complications occurred in 11 patients (5.0%) of the 220 patients. Among those 11 patients with bleeding complications, 10 patients (7.7%) had thrombocytopenia (platelet count <150k) of the 130 patients, and 1 patient (1.1%) had a normal platelet count of the 90 patients. There was a significant difference between the patient groups regarding bleeding after extractions ( P <0.001). No significant difference in the incidence of post-extraction bleeding was found between the subgroups by platelet count within the thrombocytopenia group. Conclusion Thrombocytopenia (platelet count <150k) increases the risk of post-tooth extraction bleeding. Therefore, bleeding control under the proper evaluation of hemostasis and performing delicate tooth extraction procedures using hemostatic plugs is necessary during the tooth extraction of patients with thrombocytopenia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The incidence of postoperative hemorrhage after tooth extraction in patients with thrombocytopenia

Kang

2021

JKAOMS

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“…comorbidity. 9,[15][16][17][18][35][36][37][38][39][40] Unfortunately, in the studies selected for our review, information on bleeding manifestations and comorbidity was too limited to address this issue, and information on platelet abnormalities was absent altogether. Also in this particular patient, these factors were unknown but they could have played a significant role in the occurrence of the bleedings.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…1,12,13 For many procedures the exact bleeding risk is unknown, and also depends on other factors, such as the presence of periodontal disease, age and comorbidity of the patient. 9,[14][15][16][17][18] There are no guidelines to support dental professionals and hematologists in the management of dentoalveolar procedures in ITP patients. Methods to prevent postoperative bleeding in thrombocytopenic patients include local hemostatic techniques (primary closure, minimally traumatizing techniques, the use of hemostatic sponges and fibrin sealants), antifibrinolytics, and increasing the platelet count.…”

Section: Introductionmentioning

confidence: 99%

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

Dijk

Corrêa

Schutgens

et al. 2021

TH Open

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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.

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Bleeding and Clotting Disorders

Napeñas¹,

Patton²

2021

Burket's Oral Medicine

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Dental health care workers are increasingly called upon to provide quality dental care to individuals whose bleeding and clotting mechanisms have been altered by inherited or acquired diseases. This provides an opportunity for the dentist who is trained in the recognition of oral and systemic signs of altered hemostasis to assist in the diagnosis of the underlying condition. A number of dental procedures result in the risk of bleeding that can have serious consequences, such as severe hemorrhage or possibly death, for the patient with a bleeding disorder. Safe dental care may require consultation with the patient's physician, systemic management, and dental treatment modifications.Of the inherited coagulopathies, von Willebrand's disease (vWD) is the most common. It results from deficiency of von Willebrand's factor (vWF) and affects about 0.8 to 1% of the population. 1 Hemophilia A, caused by coagulation factor (F) VIII deficiency, is the next most common, followed by hemophilia B, a F IX deficiency. The age-adjusted prevalence of hemophilia in six surveillance states in 1994 was 13.4 cases in 100,000 males (10.5 for hemophilia A and 2.9 for hemophilia B). 2 Application to the US population resulted in an estimated national prevalence of 13,320 cases of hemophilia A and 3,640 cases of hemophilia B, with an incidence rate of 1 per 5,032 live male births. Hemophilia A was predominant, accounting for 79% of all hemophiliacs, and prevalence of disease severity was 43% severe (< 1% F VIII), 26% moderate (1-5% F VIII), and 31% with mild (6-30% F VIII) disease. 2 Acquired coagulation disorders can result from drug actions or side effects, or underlying systemic disease. A stratified household sample of 4,163 community residents aged 65 years or older living in a five-county area of North Carolina revealed 51.7% to be taking one or more medications (aspirin, warfarin, dipyridamole, nonsteroidal anti-inflammatory drugs

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World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review

Cited by 14 publications

References 31 publications

The incidence of postoperative hemorrhage after tooth extraction in patients with thrombocytopenia

The incidence of postoperative hemorrhage after tooth extraction in patients with thrombocytopenia

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

Bleeding and Clotting Disorders

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