Dentoalveolar surgeryOral Surgical Treatment of Patients With Chronic Liver Disease: Assessments of Bleeding and Its Relationship With Thrombocytopenia and Blood Coagulation Parameters
Section snippets
Study Population
The study population was derived from 1,135 patients referred to the Oral Surgery Section by the Liver Transplant Center from June 1, 2013 to June 1, 2015, as a part of the procedure track for candidates to receive a liver transplant. All patients underwent a preliminary visit to assess the following parameters of their oral cavity: hygiene, missing elements, and the presence of caries, periodontal disease, root residue, and osteolysis. Of the 1,135 patients, 318 (28%) required 1 or more tooth
Results
Of the 318 patients in our study, 271 (85%) met the intention-to-treat conditions. The remaining 47 patients (15%) required urgent surgery despite the presence of 1 or 2 presumed risk factors (PRFs) because of an imminent transplant. Of the 47 patients, 34 had a PTL of 40 × 103/μL or less, 10 had an INR of 2.5 or more, and 3 had both a PTL of 40 × 103/μL or less and an INR of 2.5 or more.
In our analysis, the liver diseases were grouped as follows. Group 1 included postalcoholic cirrhosis
Discussion
Our data analysis evidenced a very satisfactory outcome for extractions in patients awaiting liver transplantation. The overall severe BR was 3.1% (10 of 318) per patient and 1% (12 of 1183) per extraction. These rates included patients with an INR as high as 2.7 and a PLT as low as 25 × 103/μL.
Our findings support the validity of our intention-to-treat procedure, which requires a PLT greater than 40 × 103/μL and an INR less than 2.5, before proceeding with tooth extraction. Patients who
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Cited by (27)
EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis
2022, Journal of HepatologyCitation Excerpt :Procedures associated with a low risk (i.e., ≤1.5%) and a high risk (>1.5%) of bleeding are reported in Table 2 (47,48,51,53,54,56,75–81). Overall, in stable patients with cirrhosis, diagnostic endoscopic procedures (e.g., gastroscopy or colonoscopy with mucosal biopsies), thoracentesis, paracentesis, trans-oesophageal echocardiography, transjugular liver biopsy and hepatic venous pressure gradient measurement, are mainly associated with a low risk of bleeding, and the occurrence of bleeding episodes has not been related to either INR values or degree of thrombocytopenia (reviewed in61,80) (Table 3).45,47–56,58,60,66,68,76–79,81–103 Percutaneous ablation of hepatocellular carcinoma is another procedure where the risk of bleeding is considered low, although in the largest series reporting the occurrence of haemorrhagic complications (0.5% in 1,834 procedures), median platelet count was 140 × 109/L and patients with a pre-procedural platelet count <50 × 109/L received 10 units of packed platelets as prophylaxis.53
Assessment of laboratory tests and intraoperative bleeding in patients with liver cirrhosis undergoing tooth extractions
2022, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyTreatment of bleeding in patients with liver disease
2021, Journal of Thrombosis and HaemostasisRisk of bleeding during oral surgery in patients with liver cirrhosis: A systematic review
2021, Journal of the American Dental AssociationCitation Excerpt :It should also be emphasized that efficient hemostasis requires only 20% through 50% of the normal level of most procoagulants.30 Perhaps it would be more prudent to avoid transfusions before dental procedures, as this approach does not benefit the patient, increases the cost of treatment for the patient, and exposes the patient to several adverse effects (for example, risk of experiencing infectious agent transmission and developing reactive thrombocytopenia).14,16,20,39,41,42 Results from our systematic review are supported with strong evidence.
Is It Safe to Remove Teeth in Liver Transplant Patients Without Antibiotics? A Retrospective Study of 346 Patients
2019, Journal of Oral and Maxillofacial SurgeryDirect Oral Anticoagulants and Medical Comorbidities in Patients Needing Dental Extractions: Management of the Risk of Bleeding
2019, Journal of Oral and Maxillofacial Surgery