Panis, K.J. (2010) Anticoagulantia en hun implicaties voor bloedige tandheelkundige ingrepen: een literatuuroverzicht. thesis, Dentistry.
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Abstract
Objectives: This study is intended to provide understanding of different anticoagulant medications and their complications for invasive dental procedures expected to cause bleeding. The aim is to find evidence for continuing, modifying or discontinuing anticoagulant therapy before invasive dental treatment, using existing literature. Methods: With the help of a PICO, the international literature was searched systematically. The following electronic online databases were used: MEDLINE/PubMed, EMBASE and Cochrane Library. Publication types included were randomised controlled trials, controlled clinical trials, systematic reviews and case series. Searches were limited to the English language and to studies involving human subjects. The period searched was from 1966 to 2009. A study was included if one of the 3 types of anticoagulation was used (heparins, cumarinederivates or platelet aggregation inhibitors). The anticoagulant therapy had to be continued or modified for an invasive dental treatment. Quality assessment was done, using predefined criteria lists. Results: After study identification and selection, 40 studies were included. Because of variations in study designs and absence of clinical subgroup homogeneity, the results did not lend themselves for pooling and a meta-analysis. Few data were found on heparine-use as anticoagulant during dental procedures. One publication studied the use of low molecular weight heparin as bridging therapy. Three systematic reviews were found aimed on cumarinederivates. No increased risk for significant bleeding was found. The seriousness of thromboembolic consequences was confirmed by 4 fatally embolic complications caused by withdrawing continuous anticoagulation for dental procedures. Also three clinical trials were included. In 603 patients, more than 977 teeth were extracted. Twenty bleeding complications occured, all were easily controlled with local hemostatic measures. In 7 studies, 388 patients on antiplatelet therapy, had more than 670 extractions. Nine patients had bleeding problems, also all easily controlled with local hemostatic measures. None of the studies had an adequate follow-up to detect thromboembolic complications. Conclusion: Routine discontinuation anticoagulant therapy before invasive dental treatment is outdated. Thromboembolic complications (as a result of discontinuing anticoagulant therapy) have greater consequences than bleeding complications (as a result of continuing anticoagulant therapy). The treatment of anticoagulated patients depends on several factors; type of anticoagulation, presence of co-existing factors, anticoagulation intensity (INR level), the clinical indication for anticoagulation (risk of thromboembolism) and the bleeding risk of the dental procedure. A management algorithm can be useful for the general practitioner for deciding how to treat or refer the anticoagulated patient.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Bos, Prof. R.R.M. and Afdeling kaakchirurgie, UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:51 |
| Last Modified: | 25 Jun 2020 10:51 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1256 |
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