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Pouplin A, Pham Kormann D, Dolivet G, Phulpin B. Hemorrhagic shock after dental extractions in a patient with anticoagulant and antiplatelet therapy: a case report. Int J Surg Case Rep 2025; 131:111375. [PMID: 40300508 PMCID: PMC12059397 DOI: 10.1016/j.ijscr.2025.111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Revised: 04/15/2025] [Accepted: 04/24/2025] [Indexed: 05/01/2025] Open
Abstract
INTRODUCTION Hemorrhagic shock requiring red blood cell transfusion following tooth extraction is rare. CASE PRESENTATION We report the case of a 71-year-old patient who was treated at the hospital for hemorrhagic shock the day after the extraction of two teeth and for a second episode seven days after the surgery. The patient was treated in oncology and his medication included acetylsalicylate of DL-Lysine and Tinzaparine. The pre-operative biological assessment that allowed the surgery and validation of the action to be taken was provided by the cardiologist. Treatment consisted in transfusion and wound revision with controlled hemostasis. DISCUSSION Alveolar bleeding leading to two episodes of hemorrhagic shock (on day 1 and day 7) is an exceptionally rare occurrence. Even if the patient had some risk factors increasing the risks of bleeding, including age, anticoagulants, oncological treatments and recent teeth extractions, no case in the scientific literature was found with similar conditions and no explanation justifying the intensity of the hemorrhage. CONCLUSION Precautions for hemostasis during the intervention are important but sometimes insufficient. For patients at high risk of bleeding with comorbidity like anticoagulant and antiplatelet therapy, it is necessary to establish 7-day postoperative monitoring to control possible post-operative bleeding.
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Affiliation(s)
- Alexia Pouplin
- Université de Lorraine, CHRU-Nancy, Service d'Odontologie, Département de chirurgie orale, F-54000 Nancy, France; Université de Lorraine, Faculté d'Odontologie, F-54500 Nancy, France
| | - Diane Pham Kormann
- Institut de Cancérologie de Lorraine, Unité de chirurgie cervico-faciale et dentaire, F-54519 Vandoeuvre-lès-Nancy, France
| | - Gilles Dolivet
- Université de Lorraine, Faculté d'Odontologie, F-54500 Nancy, France; Institut de Cancérologie de Lorraine, Unité de chirurgie cervico-faciale et dentaire, F-54519 Vandoeuvre-lès-Nancy, France; Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France
| | - Bérengère Phulpin
- Université de Lorraine, CHRU-Nancy, Service d'Odontologie, Département de chirurgie orale, F-54000 Nancy, France; Université de Lorraine, Faculté d'Odontologie, F-54500 Nancy, France; Institut de Cancérologie de Lorraine, Unité de chirurgie cervico-faciale et dentaire, F-54519 Vandoeuvre-lès-Nancy, France; Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France.
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Lee JY, Park SH, Kim DM, Ko KA, Park JY, Lee JS, Jung UW, Cha JK. Risk of post-operative bleeding after dentoalveolar surgery in patients taking anticoagulants: a cohort study using the common data model. Sci Rep 2024; 14:7787. [PMID: 38565933 PMCID: PMC10987490 DOI: 10.1038/s41598-024-57881-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
This retrospective study aimed to determine risk factors associated with post-operative bleeding after dentoalveolar surgery in patients taking anticoagulants. Patients taking anticoagulants who were planned to undergo periodontal flap operation, tooth extraction or implant surgery were included. Patients were divided into two subgroups according to the maintenance of anticoagulants following medical consultation: (1) maintenance group and (2) discontinuation group. The analysed patient-related factors included systemic diseases, maintenance of anticoagulants and types of anticoagulant. Intra- and post-operative treatment-related factors, haemostatic methods and post-operative bleeding were collected for statistical analyses. There were 35 post-operative bleeding complications (6.5%) in the 537 included patients: 21 (8.6%) in maintenance group and 14 (4.8%) in discontinuation group. The type of anticoagulant (p = 0.037), tooth extraction combined with bone grafting (p = 0.016) and type of implant surgery (p = 0.032) were significantly related to the post-operative bleeding rate. In the maintenance group, atrial fibrillation [odds ratio (OR) = 6.051] and vitamin K inhibitors (OR = 3.679) were associated with a significantly higher bleeding risk. From this result, it can be inferred that the decision to continue anticoagulants should be made carefully based on the types of anticoagulant and the characteristics of dentoalveolar surgeries performed: extraction with bone grafting, multiple implantations and involvement of maxillary arch.
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Affiliation(s)
- Joo-Yeon Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seung-Hyun Park
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Da-Mi Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyung-A Ko
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jin-Young Park
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Patient Assessment. J Oral Maxillofac Surg 2023; 81:E13-E34. [PMID: 37833021 DOI: 10.1016/j.joms.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Puia SA, Hilber EM, Garcia-Blanco M. Bleeding Complications in Relation to the International Normalized Ratio for Dental Extractions in Patients under Chronic Anticoagulant Therapy - An Evaluative Study. Ann Maxillofac Surg 2022; 12:139-143. [PMID: 36874771 PMCID: PMC9976852 DOI: 10.4103/ams.ams_113_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/10/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Recent simple dental extraction protocols suggest that therapeutic levels of the anticoagulant drug should be maintained because bleeding complications could be managed with local haemostasis manoeuvres. The aim of the present study was to evaluate the association between bleeding complications and the international normalized ratio (INR) values in patients after dental extractions completed with a plug of bismuth subgallate, without interrupting anticoagulant administration. Materials and Methods Patients undergoing oral Vitamin K antagonist chronic anticoagulant therapy requiring simple dental extractions were included in the study. INRs were recorded on the day of the surgery, and dental extractions were performed applying bismuth subgallate as a haemostatic agent. Patients took their anticoagulation drug normally. Bleeding complications were recorded. Results The study included 694 patients, of whom 11 (1.58%) presented mediate post-operative bleeding that was effectively controlled through local manoeuvres. No episode of thromboembolism or infectious endocarditis was observed. The incidence of bleeding complications was not related to the INR values (P > 0.05). Discussion INR values were not related to bleeding complications when simple dental extractions were performed applying bismuth subgallate as a haemostatic agent.
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Affiliation(s)
- Sebastian Ariel Puia
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Ezequiel Matias Hilber
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Matias Garcia-Blanco
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
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Risk factors for bleeding after dental extractions in patients receiving antithrombotic drugs - A case control study. J Dent Sci 2022; 17:780-786. [PMID: 35756819 PMCID: PMC9201513 DOI: 10.1016/j.jds.2021.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/02/2021] [Indexed: 02/08/2023] Open
Abstract
Background/purpose Patients receiving antithrombotic drugs are more likely to suffer bleeding after tooth extraction and multiple factors are related to it. The aim of this study was to investigate the incidence of bleeding and risk factors for bleeding after dental extractions in patients receiving antithrombotic drugs. Materials and methods This retrospective case control study included patients receiving oral antithrombotic drugs or not. Tooth extractions were conducted under ECG monitoring and local hemostatic measures were performed. Risk factors for postoperative hemorrhage after tooth extraction were evaluated using univariate and multivariate analyses. Results Bleeding events were reported in 27 (27%) patients receiving antithrombotic drugs and 9 (9%) patients who didn't use antithrombotic drugs, the difference between which was significant (p < 0.01). Univariate analyses showed that age (OR = 2.717, p = 0.028), oral hygiene (OR = 4.110, p = 0.043), inferior nerve block (OR = 4.285, p = 0.038) and number of extracted tooth (OR = 4.758, p = 0.029) were significantly correlate with bleeding incidence. Multivariate analysis revealed that age (OR = 2.824, p = 0.036) and number of extracted tooth (OR = 5.268, p = 0.016) were significant risk factors for postextraction bleeding. Conclusion The results suggest that there is higher incidence of postextraction bleeding in patients receiving antithrombotic drugs compared to patients who don't. Age (>75 years), oral hygiene, inferior nerve block and number of extracted tooth may be related to bleeding after tooth extraction.
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Kang SH, Kang MJ. The incidence of postoperative hemorrhage after tooth extraction in patients with thrombocytopenia. J Korean Assoc Oral Maxillofac Surg 2021; 47:190-196. [PMID: 34187959 PMCID: PMC8249185 DOI: 10.5125/jkaoms.2021.47.3.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022] Open
Abstract
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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Affiliation(s)
- Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Min-Jun Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Pippi R, Luigetti L, Scorsolini MG, Pietrantoni A, Cafolla A. Is telephone follow-up useful in preventing post-extraction bleeding in patients on antithrombotic treatment? J Clin Exp Dent 2021; 13:e140-e147. [PMID: 33574998 PMCID: PMC7864370 DOI: 10.4317/jced.57401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/10/2020] [Indexed: 11/27/2022] Open
Abstract
Background The aim of the study was to investigate the usefulness of telephone follow-up in preventing post-extraction bleeding and improving wound healing in patients on chronic antithrombotic treatment.
Material and Methods A prospective randomized clinical trial was carried out on 256 patients (test group = 128; control group = 128). The exact two-tailed Fisher test and the two-tailed non-parametric Mann-Whitney test were used for statistical analysis.
Results The incidence of post-extraction bleeding was 15.6% and there was no difference between test and control groups. However, the study group was significantly, though weakly, associated with the severity of bleeding. Patient satisfaction with post-operative follow-up differed significantly between patients who had and those who did not have post-extraction bleeding.
Conclusions Telephone follow-up after tooth extraction may play a role in the prevention of severe post-operative bleeding as well as in monitoring and managing the surgical wound. Key words:Post-operative instructions, patient satisfaction, wound healing.
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Affiliation(s)
- Roberto Pippi
- Associate Professor of Oral Surgery. Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome
| | - Luca Luigetti
- Oral surgeon. Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome
| | - Maria-Giulia Scorsolini
- Post-graduate student in Oral Surgery. Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome
| | - Alessandra Pietrantoni
- Oral surgeon. Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome
| | - Arturo Cafolla
- Aggregate Professor of Hematology. Sapienza University of Rome
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Pippi R, Scorsolini MG, Luigetti L, Pietrantoni A, Cafolla A. Tooth extraction without discontinuation of oral antithrombotic treatment: A prospective study. Oral Dis 2020; 27:1300-1312. [PMID: 32920926 DOI: 10.1111/odi.13641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify which variable, among those related to surgeries, to patients, or to antithrombotic treatments, could be considered as a bleeding indicator, and to analyze effectiveness of the local hemostatic protocols used, incidence of bleeding and healing index, depending on the number of extracted teeth, and patient antithrombotic treatment. METHODS Patients who underwent tooth extractions without interruption or reduction of antithrombotic treatment were prospectively followed. The exact two-tailed Fisher test was used to investigate the relationship between presence/absence of bleeding and type of hemostatic material. The effect of variables on the probability of bleeding and healing index was assessed by means of a multivariate logistic regression. RESULTS Two hundred and fifty-four procedures were analyzed. The incidence of bleeding was 15.75%. Severe bleeding occurred in only 6 patients (2.34%). The number of involved dental quadrants and pre-surgical antibiotic treatments were found to be positively related with bleeding. The use of vasoconstrictors during surgery resulted in a reduction of healing index scores. CONCLUSIONS Tooth extractions in patients on antithrombotic treatment were found to be free from significant bleeding although the involvement of more than 1 quadrant in the same procedure should be avoided.
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Affiliation(s)
- Roberto Pippi
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Giulia Scorsolini
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Luigetti
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra Pietrantoni
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
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Kubota K, Yamaga E, Ueda K, Inokoshi M, Minakuchi S. Comparison of cardiovascular response between patients on warfarin and hypertensive patients not on warfarin during dental extraction. Clin Oral Investig 2020; 25:2141-2150. [PMID: 32808177 DOI: 10.1007/s00784-020-03526-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate cardiovascular response in patients on warfarin and hypertensive patients not on warfarin during dental extraction. MATERIALS AND METHODS This retrospective study included 53 patients who had undergone dental extraction while on warfarin (mean age 78.8 ± 6.3 years, 26 men) and 66 with hypertension who had undergone dental extraction but were not on warfarin (mean age 77.4 ± 6.8 years, 22 men). Vital signs were monitored in both groups during extraction. RESULTS The highest systolic blood pressure (SBP) values (mean 150.1 ± 21.1 mmHg) were observed in patients on warfarin before (9.0%) and after (10.3%) administration of local anesthesia (LA), during extraction (39.7%), and during (33.3%) and after (7.7%) suturing (n = 78; p < 0.01), and in hypertensive patients not receiving warfarin (160.6 ± 24.8 mmHg) before (19.2%) and after (27.3%) administration of LA, during extraction (29.3%), and during (18.2%) and after (6.1%) suturing (n = 99; p < 0.01). The highest SBP was linearly correlated with SBP before administration of LA in patients on warfarin (highest SBP = 0.9415 × SBP before LA + 23.243, R2 = 0.75481) and in hypertensive patients not on warfarin (highest SBP = 1.0027 × SBP before LA + 15.789, R2 = 0.60341). CONCLUSIONS The highest SBP was not distributed evenly between patients on warfarin and hypertensive patients not on warfarin during dental extraction and was strongly associated with SBP before LA regardless of anticoagulant status. CLINICAL RELEVANCE Thorough management of SBP is required in patients on warfarin to avoid thromboembolism and major hemorrhagic complications. Knowing the SBP value before dental treatment would help predict the risk of cardiovascular complications.
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Affiliation(s)
- Kazumasa Kubota
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Eijiro Yamaga
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Kaori Ueda
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Masanao Inokoshi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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Yamada SI, Hasegawa T, Soutome S, Yoshimura H, Miyakoshi M, Ueda N, Okamoto K, Hishida S, Rokutanda S, Nakahara H, Fujita S, Akashi M, Kitagawa Y, Kirita T, Shibuya Y, Umeda M, Kurita H. Prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction on warfarin therapy: a multicenter retrospective study in Japan. Odontology 2019; 108:462-469. [PMID: 31705338 DOI: 10.1007/s10266-019-00474-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/26/2019] [Indexed: 11/26/2022]
Abstract
Postoperative hemorrhage after tooth extraction is a critical and clinically important issue for clinicians and patients receiving anticoagulants. The purpose of the present study was to investigate the prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction in Japanese patients receiving warfarin therapy. A total of 142 patients who underwent lower third molar extraction between January 2010 and December 2016 were included, and their medical records were retrospectively reviewed. The prevalence of and risk factors for postoperative hemorrhage were investigated. The prevalence of postoperative hemorrhage after lower third molar extraction was significantly higher in patients receiving warfarin than in healthy subjects (21.8% vs 0.7%, P < 0.001). The cutoff value for PT-INR was 2.11 based on a receiver-operating characteristic analysis. A multivariate analysis indicated that an elevated PT-INR value [hazard ratio (HR) 3.798, 95% confidence interval (CI) 1.400-10.467, P < 0.01], preoperative antibiotic administration (HR 4.434, 95% CI 1.591-14.775, P < 0.01), difficulties with intraoperative hemostasis (HR 16.298, 95% CI 2.986-110.677, P < 0.01), and higher serum creatinine levels (HR 7.465, 95% CI 1.616-39.576, P < 0.05) are significant predictors of postoperative hemorrhage after lower third molar extraction. Multivariate correlations were observed between risk factors including an elevated PT-INR value, preoperative antibiotic administration, and higher serum creatinine levels, and postoperative hemorrhage after lower third molar extraction in patients receiving warfarin therapy. Clinicians need to consider these risk factors for postoperative hemorrhage after the lower third molar extraction and monitor PT-INR in patients receiving warfarin therapy.
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Affiliation(s)
- Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sakiko Soutome
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masaaki Miyakoshi
- Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuhiro Ueda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Kenjiro Okamoto
- Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - Sumiyo Hishida
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Rokutanda
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirokazu Nakahara
- Department of Dentistry and Oral Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
| | - Shigeyuki Fujita
- Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimasa Kitagawa
- Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Yasuyuki Shibuya
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
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van der Vorm LN, Brouwers JEIG, Mondria C, de Laat B, de Groot PG, Remijn JA. Salivary tissue factor induces thrombin generation in a diurnal rhythm. Res Pract Thromb Haemost 2018; 2:757-761. [PMID: 30349895 PMCID: PMC6178728 DOI: 10.1002/rth2.12130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Upon tooth extraction, extravascular tissue factor (TF) initiates coagulation to arrest bleeding. Additionally, saliva is in constant contact with the wound and contains extracellular vesicle-derived procoagulant TF. Since the duration of postextraction bleeding is highly variable between patients, we hypothesized this may be caused by variation in saliva-derived TF-induced clotting activity. OBJECTIVES We aimed to assess the variability of saliva-induced thrombin generation (TG) in healthy individuals. METHODS TG was performed according to the calibrated automated thrombinography (CAT) method. Diluted saliva was added (instead of recombinant TF and phospholipids [PL]) to normal pooled plasma (NPP) in the absence/presence of anti-TF antibodies. Saliva was collected from healthy individuals in the morning, afternoon and evening. RESULTS Addition of saliva to NPP induced TG curves similar to those induced by r-TF and PL. Moreover, addition of anti-TF antibodies abolished saliva-induced TG, indicating TF-dependence. A large inter-individual variability (peak CV 31%, range 73-220 nmol/L thrombin) in saliva-induced TG was observed. Interestingly, within subjects, saliva-induced TG was significantly (P = 0.009) increased in the morning (167 ± 40 nmol/L thrombin) compared to the afternoon (124 ± 39 nmol/L thrombin) and evening (123 ± 38 nmol/L thrombin). This diurnal variation was not attributable to gingival stimulation or damage induced by tooth brushing. CONCLUSIONS We identified a diurnal rhythm in salivary TF activity that may have implications for tooth extraction and dental surgery, as performing invasive procedures in the morning may be beneficial for rapid coagulation. Future studies should correlate salivary TF to clinical outcome (ie, postextraction bleeding) and assess a possible relation with bacterial status in the oral cavity.
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Affiliation(s)
- Lisa N. van der Vorm
- Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtthe Netherlands
- Synapse Research InstituteMaastrichtthe Netherlands
- Department of Clinical Chemistry and HematologyGelre HospitalsApeldoornthe Netherlands
| | | | - Ceráya Mondria
- Department of Clinical Chemistry and HematologyGelre HospitalsApeldoornthe Netherlands
| | - Bas de Laat
- Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtthe Netherlands
- Synapse Research InstituteMaastrichtthe Netherlands
- Department of Clinical Chemistry and HematologyGelre HospitalsApeldoornthe Netherlands
| | - Philip G. de Groot
- Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtthe Netherlands
- Synapse Research InstituteMaastrichtthe Netherlands
| | - Jasper A. Remijn
- Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtthe Netherlands
- Department of Clinical Chemistry and HematologyGelre HospitalsApeldoornthe Netherlands
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