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Nanayakkara L, Yahaya N, Parreira M, Bajkin B. Dental management of people with complex or rare inherited bleeding disorders. Haemophilia 2024; 30 Suppl 3:128-134. [PMID: 38571337 DOI: 10.1111/hae.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
Advances in haematological therapies for people with complex or rare inherited bleeding disorders (IBD) have resulted in them living longer, retaining their natural teeth with greater expectations of function and aesthetics. Dental management strategies need to evolve to meet these challenges. Utilising low level laser diode therapy to reduce pre-operative inflammation to reduce the intraoperative and postoperative burden on haemostasis is described in a case series of 12 patients. For these individuals who previously required further medical management to support haemostasis or experienced such prolonged haemorrhage sufficient to warrant hospital admission, haemostasis was achieved in the dental surgery such that they were able to return home with no further medical intervention or overnight stays. Global inequities in accessing novel treatments for complex or rare IBD necessitates a comprehensive understanding of the local haemostatic agents available to dentists and the most commonly used agents and techniques are described including the use of single tooth anaesthesia (STA). STA is a computerised delivery mechanism that allows routine dental procedures that would previously have required block injections needing factor replacement therapy to be undertaken safely and effectively with no additional haemostatic intervention. The challenges of inhibitors in oral surgery are explained and discussed although more research and evidence is required to establish new treatment protocols. The importance of establishing good dental health in the quality of life of people with complex or rare IBD is highlighted with respect to the dental specific impact that more novel therapies may have on people with IBD.
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Affiliation(s)
- Lochana Nanayakkara
- Department of Restorative Dentistry, Royal London Hospital, BartsHealth NHS Trust, London, UK
- Institute of Dentistry Queen Mary University of London, London, UK
| | - Norjehan Yahaya
- Special Care Dentistry Unit, Department of Oral and Maxillofacial Surgery, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
| | - Miryam Parreira
- Dental Surgery Department, University of Buenos Aires, Buenos Aires, Argentina
- Foundation of Haemophilia, Buenos Aires, Argentina
| | - Branislav Bajkin
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Dental Clinic of Vojvodina, Novi Sad, Serbia
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Park JW, Kim TW, Chang CB, Han M, Go JJ, Park BK, Jo WL, Lee YK. Effects of Thrombin-Based Hemostatic Agent in Total Knee Arthroplasty: Meta-Analysis. J Clin Med 2023; 12:6656. [PMID: 37892794 PMCID: PMC10607432 DOI: 10.3390/jcm12206656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The effectiveness of Floseal, a thrombin-based hemostatic matrix, in total knee arthroplasty (TKA) in minimizing blood loss and transfusion requirements remains a topic of debate. This meta-analysis aims to evaluate the up-to-date randomized controlled trials (RCTs) on the efficacy and safety of Floseal in TKA. A comprehensive search was conducted in electronic databases to identify relevant RCTs. The methodological quality of the included studies was assessed, and data extraction was performed. The pooled effect sizes were calculated using standardized mean difference (SMD) or odds ratios (OR) with 95% confidence intervals (CIs). Eight studies involving 904 patients were included in the meta-analysis. The use of a thrombin-based hemostatic agent significantly reduced hemoglobin decline (SMD = -0.49, 95% CI: -0.92 to -0.07) and the risk of allogenic transfusion (OR = 0.45, 95% CI: 0.25 to 0.81) but showed no significant difference in the volume of drainage or total blood loss. Funnel plots showed no evidence of publication bias. This meta-analysis provides robust evidence supporting the effectiveness of Floseal in reducing hemoglobin decline and transfusion in TKA. Further well-designed RCTs with longer follow-up periods are warranted to assess long-term efficacy and safety.
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Minji Han
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Republic of Korea;
| | - Jong Jin Go
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
| | - Byung Kyu Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
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Campana MD, Aliberti A, Acerra A, Sammartino P, Dolce P, Sammartino G, Gasparro R. The Effectiveness and Safety of Autologous Platelet Concentrates as Hemostatic Agents after Tooth Extraction in Patients on Anticoagulant Therapy: A Systematic Review of Randomized, Controlled Trials. J Clin Med 2023; 12:5342. [PMID: 37629387 PMCID: PMC10455824 DOI: 10.3390/jcm12165342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
One of the common challenges in oral surgery is dealing with patients who are taking oral anticoagulant/antiaggregant drugs. Several local hemostatic agents have been proposed as an alternative to conventional suturing. Among these, autologous platelet concentrates (APCs) have been widely used to decrease the risk of hemorrhage after dental extraction. Nevertheless, there is a lack of consensus regarding the superiority of any one specific hemostatic agent over the others. This systematic review is aimed at evaluating the effectiveness of APCs as hemostatic agents after tooth extraction in patients on anticoagulant therapy. A literature search was conducted of articles published before March 2023 on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies on the use of APCs in patients undergoing dental extractions and being treated with anticoagulant drugs were included. Only randomized, controlled trials (RCTs) published up to March 2023 were included; the outcomes assessed were the time to hemostasis, the presence of post-operative bleeding and pain, and the effectiveness of wound healing. The risk of bias for each RCT was assessed by using the 'risk of bias' tool (RoB 1.0). The research revealed 6 RCTs. The findings indicated that patients on anticoagulant therapy who received APCs without discontinuing their medication experienced a decreased post-operative bleeding, a shorter hemostasis time, reduced pain, and accelerated wound healing. However, due to the high/unclear risk of bias of the studies included, no definitive conclusions can be drawn on the superiority of APCs as hemostatic agents over other similar products. Additional studies are required to validate these findings.
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Affiliation(s)
- Maria Domenica Campana
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
| | - Angelo Aliberti
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
| | - Alfonso Acerra
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
| | - Pasquale Sammartino
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Gilberto Sammartino
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
| | - Roberta Gasparro
- Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (M.D.C.); (A.A.); (A.A.); (R.G.)
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Gelatin-based hemostatic agents for medical and dental application at a glance: A narrative literature review. Saudi Dent J 2022; 34:699-707. [PMID: 36570577 PMCID: PMC9767835 DOI: 10.1016/j.sdentj.2022.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
Uncontrolled bleeding is linked to higher treatment costs, risk of post-surgical infection and increased disease and death. Hemostatic agents are used to treat excessive bleeding. A good hemostatic agent controls bleeding effectively, reduces the need for blood transfusion, removes the need for systemic drugs to control bleeding, results in shorter surgery time, and reduces the cost and length of hospital stay of the patient. Gelatin-based hemostatic agents have been widely used in medical and dental procedures, owing to their biodegradability and biocompatibility, as well as availability and low cost of raw materials. In this narrative literature review, we discuss the background and different types of gelatin-based hemostatic agents in medical and dental procedures, the comparison of gelatin-based and non-gelatin-based hemostatic agents, and the usage and development of enhanced or novel gelatin-based hemostatic agents. Gelatin-based hemostatic agents are effective and important part of bleeding control, as evidenced by its wide application in medicine and dentistry. The development of novel combination gelatin-based hemostatic agents has much potential for effective control of excessive bleeding.
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Montazerian H, Davoodi E, Baidya A, Baghdasarian S, Sarikhani E, Meyer CE, Haghniaz R, Badv M, Annabi N, Khademhosseini A, Weiss PS. Engineered Hemostatic Biomaterials for Sealing Wounds. Chem Rev 2022; 122:12864-12903. [PMID: 35731958 DOI: 10.1021/acs.chemrev.1c01015] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hemostatic biomaterials show great promise in wound control for the treatment of uncontrolled bleeding associated with damaged tissues, traumatic wounds, and surgical incisions. A surge of interest has been directed at boosting hemostatic properties of bioactive materials via mechanisms triggering the coagulation cascade. A wide variety of biocompatible and biodegradable materials has been applied to the design of hemostatic platforms for rapid blood coagulation. Recent trends in the design of hemostatic agents emphasize chemical conjugation of charged moieties to biomacromolecules, physical incorporation of blood-coagulating agents in biomaterials systems, and superabsorbing materials in either dry (foams) or wet (hydrogel) states. In addition, tough bioadhesives are emerging for efficient and physical sealing of incisions. In this Review, we highlight the biomacromolecular design approaches adopted to develop hemostatic bioactive materials. We discuss the mechanistic pathways of hemostasis along with the current standard experimental procedures for characterization of the hemostasis efficacy. Finally, we discuss the potential for clinical translation of hemostatic technologies, future trends, and research opportunities for the development of next-generation surgical materials with hemostatic properties for wound management.
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Affiliation(s)
- Hossein Montazerian
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States.,California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States.,Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Elham Davoodi
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States.,California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States.,Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States.,Multi-Scale Additive Manufacturing Lab, Mechanical and Mechatronics Engineering Department, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Avijit Baidya
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Sevana Baghdasarian
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Einollah Sarikhani
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States
| | - Claire Elsa Meyer
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Reihaneh Haghniaz
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Maryam Badv
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States.,Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States.,Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Nasim Annabi
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States.,Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Paul S Weiss
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States.,California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States.,Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States.,Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
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