Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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When do we need more than local compression to control intraoral haemorrhage?

  • Sohn, Jun-Bae (Department of Oral and Maxillofacial Surgery, Seoul Metropolitan Government-Seoul National University (SMG-SNU) Boramae Medical Center) ;
  • Lee, Ho (Department of Oral and Maxillofacial Surgery, Seoul Metropolitan Government-Seoul National University (SMG-SNU) Boramae Medical Center) ;
  • Han, Yoon-Sic (Department of Oral and Maxillofacial Surgery, Seoul Metropolitan Government-Seoul National University (SMG-SNU) Boramae Medical Center) ;
  • Jung, Da-Un (Section of Dentistry, SMG-SNU Boramae Medical Center) ;
  • Sim, Hye-Young (Section of Dentistry, SMG-SNU Boramae Medical Center) ;
  • Kim, Hee-Sun (Section of Dentistry, SMG-SNU Boramae Medical Center) ;
  • Oh, Sohee (Medical Research Collaborating Center, SMG-SNU Boramae Medical Center)
  • Received : 2019.08.17
  • Accepted : 2019.10.28
  • Published : 2019.12.31
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Abstract

Objectives: The aims of this study were to determine the effectiveness of local compression in patients presenting to the emergency room with intraoral bleeding and to identify when complex haemostatic measures may be required. Materials and Methods: Five hundred forty patients who had experienced intraoral haemorrhage were retrospectively reviewed. The outcome variable was the haemostasis method used, i.e., simple (local compression with gauze) or complex (an alternative method after local compression has failed). Predictor variables were sex, age, American Society of Anesthesiologists (ASA) class, hepatic cirrhosis, bleeding disorder, use of antithrombotic agents, and site/cause of haemorrhage. Results: The mean patient age was 48.9±23.9 years, 53.5% were male, 42.8% were ASA class II or higher, and 23.7% were taking antithrombotic agents. Local compression was used most often (68.1%), followed by local haemostatic agents, sutures, systemic tranexamic acid or blood products, and electrocautery. The most common site of bleeding was the gingiva (91.7%), and the most common cause was tooth extraction (45.7%). Risk factors for needing a complex haemostasis method were use of antithrombotic agents (odds ratio 2.047, P=0.009) and minor oral surgery (excluding extraction and implant procedures; odds ratio 6.081, P=0.001). Conclusion: A haemostasis method other than local compression may be needed in patients taking antithrombotic agents or having undergone minor oral surgery.

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References

  1. Ziffer AM, Scopp IW, Beck J, Baum J, Berger AR. Profound bleeding after dental extractions during dicumarol therapy. N Engl J Med 1957;256:351-3. https://doi.org/10.1056/NEJM195702212560806
  2. Cannon PD, Dharmar VT. Minor oral surgical procedures in patients on oral anticoagulants--a controlled study. Aust Dent J 2003;48:115-8. https://doi.org/10.1111/j.1834-7819.2003.tb00019.x
  3. Bouloux GF, Perciaccante VJ. Massive hemorrhage during oral and maxillofacial surgery: ligation of the external carotid artery or embolization? J Oral Maxillofac Surg 2009;67:1547-51. https://doi.org/10.1016/j.joms.2009.03.014
  4. Bajkin BV, Popovic SL, Selakovic SD. Randomized, prospective trial comparing bridging therapy using low-molecular-weight heparin with maintenance of oral anticoagulation during extraction of teeth. J Oral Maxillofac Surg 2009;67:990-5. https://doi.org/10.1016/j.joms.2008.12.027
  5. Costa FW, Rodrigues RR, Sousa LH, Carvalho FS, Chaves FN, Fernandes CP, et al. Local hemostatic measures in anticoagulated patients undergoing oral surgery: a systematized literature review. Acta Cir Bras 2013;28:78-83. https://doi.org/10.1590/S0102-86502013000100013
  6. Scully C, Wolff A. Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:57-64. https://doi.org/10.1067/moe.2002.123828
  7. Medina JB, Andrade NS, de Paula Eduardo F, Bezinelli L, Franco JB, Gallottini M, et al. Bleeding during and after dental extractions in patients with liver cirrhosis. Int J Oral Maxillofac Surg 2018;47:1543-9. https://doi.org/10.1016/j.ijom.2018.04.007
  8. Rasaratnam L, Chowdary P, Pollard D, Subel B, Harrington C, Darbar UR. Risk-based management of dental procedures in patients with inherited bleeding disorders: Development of a Dental Bleeding Risk Assessment and Treatment Tool (DeBRATT). Haemophilia 2017;23:247-54. https://doi.org/10.1111/hae.13122
  9. Sprenker C, Omar HR, Powless RA, Mangar D, Camporesi E. Massive oral bleeding after full-mouth extraction in a patient with B-cell lymphocytic leukemia/small lymphocytic lymphoma reversed with recombinant activated factor VII. J Am Dent Assoc 2016;147:142-5. https://doi.org/10.1016/j.adaj.2015.09.001
  10. Krishnan B, Shenoy NA, Alexander M. Exodontia and antiplatelet therapy. J Oral Maxillofac Surg 2008;66:2063-6. https://doi.org/10.1016/j.joms.2008.06.027
  11. Kämmerer PW, Frerich B, Liese J, Schiegnitz E, Al-Nawas B. Oral surgery during therapy with anticoagulants-a systematic review. Clin Oral Investig 2015;19:171-80. https://doi.org/10.1007/s00784-014-1366-3
  12. Madrid C, Sanz M. What influence do anticoagulants have on oral implant therapy? A systematic review. Clin Oral Implants Res 2009;20 Suppl 4:96-106. https://doi.org/10.1111/j.1600-0501.2009.01770.x
  13. Wahl MJ, Pinto A, Kilham J, Lalla RV. Dental surgery in anticoagulated patients--stop the interruption. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119:136-57. https://doi.org/10.1016/j.oooo.2014.10.011
  14. Eichhorn W, Burkert J, Vorwig O, Blessmann M, Cachovan G, Zeuch J, et al. Bleeding incidence after oral surgery with continued oral anticoagulation. Clin Oral Investig 2012;16:1371-6. https://doi.org/10.1007/s00784-011-0649-1
  15. Morimoto Y, Nakatani T, Yokoe C, Kudo C, Hanamoto H, Niwa H. Haemostatic management for oral surgery in patients supported with left ventricular assist device--a preliminary retrospective study. Br J Oral Maxillofac Surg 2015;53:991-5. https://doi.org/10.1016/j.bjoms.2015.08.262
  16. Vezeau PJ. Topical hemostatic agents: what the oral and maxillofacial surgeon needs to know. Oral Maxillofac Surg Clin North Am 2016;28:523-32. https://doi.org/10.1016/j.coms.2016.06.007
  17. Rossmann JA, Rees TD. A comparative evaluation of hemostatic agents in the management of soft tissue graft donor site bleeding. J Periodontol 1999;70:1369-75. https://doi.org/10.1902/jop.1999.70.11.1369
  18. Ozcan M, Ucak O, Alkaya B, Keceli S, Seydaoglu G, Haytac MC. Effects of platelet-rich fibrin on palatal wound healing after free gingival graft harvesting: a comparative randomized controlled clinical trial. Int J Periodontics Restorative Dent 2017;37:e270-8. https://doi.org/10.11607/prd.3226
  19. Arora RR, Rai F. Antiplatelet intervention in acute coronary syndrome. Am J Ther 2009;16:e29-40. https://doi.org/10.1097/MJT.0b013e31804c7238
  20. Su Q, Li C, Long F, Chen B, Wan Z, Wu Y, et al. Effects of a health promotion program on medication adherence to antiplatelet therapy among ischemic stroke patients in Hainan Province, China. Vascular 2017;25:242-8. https://doi.org/10.1177/1708538116666159
  21. Pototski M, Amenabar JM. Dental management of patients receiving anticoagulation or antiplatelet treatment. J Oral Sci 2017;49:253-8. https://doi.org/10.2334/josnusd.49.253
  22. Nathwani S, Martin K. Exodontia in dual antiplatelet therapy: the evidence. Br Dent J 2016;220:235-8. https://doi.org/10.1038/sj.bdj.2016.173
  23. Li L, Zhang W, Yang Y, Zhao L, Zhou X, Zhang J. Dental management of patient with dual antiplatelet therapy: a meta-analysis. Clin Oral Investig 2019;23:1615-23. https://doi.org/10.1007/s00784-018-2591-y
  24. Napenas JJ, Oost FC, DeGroot A, Loven B, Hong CH, Brennan MT, et al. Review of postoperative bleeding risk in dental patients on antiplatelet therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:491-9. https://doi.org/10.1016/j.oooo.2012.11.001
  25. Bacci C, Berengo M, Favero L, Zanon E. Safety of dental implant surgery in patients undergoing anticoagulation therapy: a prospective case-control study. Clin Oral Implants Res 2011;22:151-6. https://doi.org/10.1111/j.1600-0501.2010.01963.x
  26. Scully C, Hobkirk J, Dios PD. Dental endosseous implants in the medically compromised patient. J Oral Rehabil 2007;34:590-9. https://doi.org/10.1111/j.1365-2842.2007.01755.x
  27. Febbo A, Cheng A, Stein B, Goss A, Sambrook P. Postoperative bleeding following dental extractions in patients anticoagulated with warfarin. J Oral Maxillofac Surg 2016;74:1518-23. https://doi.org/10.1016/j.joms.2016.04.007
  28. Gualandro DM, Yu PC, Calderaro D, Marques AC, Pinho C, Caramelli B, et al. II Guidelines for perioperative evaluation of the Brazilian Society of Cardiology. Arq Bras Cardiol 2011;96(3 Suppl 1):1-68. https://doi.org/10.1590/S0066-782X2011000800001
  29. Morimoto Y, Niwa H, Minematsu K. Risk factors affecting postoperative hemorrhage after tooth extraction in patients receiving oral antithrombotic therapy. J Oral Maxillofac Surg 2011;69:1550-6. https://doi.org/10.1016/j.joms.2010.10.018