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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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Mahardawi B, Jiaranuchart S, Arunjaroensuk S, Tompkins KA, Somboonsavatdee A, Pimkhaokham A. The effect of different hemostatic agents following dental extraction in patients under oral antithrombotic therapy: a network meta-analysis. Sci Rep 2023; 13:12519. [PMID: 37532770 PMCID: PMC10397210 DOI: 10.1038/s41598-023-39023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
This network meta-analysis was done to thoroughly evaluate the available literature on the use of different hemostatic agents for dental extraction in patients under oral antithrombotic therapy, aiming to identify the agent with the best/worst performance in bleeding control. Considering that such patients have a higher risk of bleeding, choosing the right hemostatic is essential. Twenty-three randomized clinical trials articles were included after completing the literature search. Cyanoacrylate tissue adhesive showed a reduction in the odds of postoperative bleeding events compared with conventional methods (i.e., gauze/cotton pressure, sutures), with a tendency toward a statistical significance (OR 0.03, P = 0.051). Tranexamic acid was the only agent that demonstrated a significantly lower risk of developing postoperative bleeding events (OR 0.27, P = 0.007). Interestingly, chitosan dental dressing and collagen plug had the shortest time to reach hemostasis. However, they ranked last among all hemostatic agents, regarding bleeding events, revealing higher odds than conventional measures. Therefore, it is concluded that the use of cyanoacrylate tissue adhesive and tranexamic acid gives favorable results in reducing postoperative bleeding events following dental extractions. Although chitosan dental dressing and collagen exhibited a faster time to reach hemostasis, they led to a higher occurrence of bleeding events.
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Affiliation(s)
- Basel Mahardawi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Sirimanas Jiaranuchart
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Sirida Arunjaroensuk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Kevin A Tompkins
- Office of Research Affairs, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Anupap Somboonsavatdee
- Department of Statistics, Chulalongkorn Business School, Chulalongkorn University, Bangkok, Thailand
| | - Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand.
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Boccatonda A, Frisone A, Lorusso F, Bugea C, Di Carmine M, Schiavone C, Cocco G, D’Ardes D, Scarano A, Guagnano MT. Perioperative Management of Antithrombotic Therapy in Patients Who Undergo Dental Procedures: A Systematic Review of the Literature and Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5293. [PMID: 37047909 PMCID: PMC10093975 DOI: 10.3390/ijerph20075293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The surgical dental treatment of subjects admitted for anticoagulants therapy represents a consistent risk for peri-operative bleeding. The aim of the present study was to investigate the clinical findings of dental surgery operative management of the patients under anticoagulants drugs protocol. METHODS The literature screening was performed using Pubmed/Medline, EMBASE and Cochrane library, considering only randomized clinical trials (RCTs) papers. No limitations about the publication's period, follow-up time or clinical parameters were considered. RESULTS A total of eight RCTs were included for the qualitative synthesis. No thromboembolic complications were reported in any studies. Several bleeding episodes associated with anticoagulant drugs in dental surgery were mild and generally happened on the first day after the treatment. CONCLUSIONS The use of local haemostatic measures is generally effective for bleeding control with no further pharmacological drug management or suspension.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bentivoglio, Italy
| | - Alessio Frisone
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Calogero Bugea
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Maristella Di Carmine
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
| | - Cosima Schiavone
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Giulio Cocco
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Damiano D’Ardes
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100 Chieti, Italy
- Department of Oral Implantology, Dental Research Division, College Ingà, UNINGÁ, Cachoeiro de Itapemirim 29312, ES, Brazil
| | - Maria Teresa Guagnano
- Department of Medicine and Science of Aging, “G. d’Annunzio” University, 66100 Chieti, Italy
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Aminoshariae A, Donaldson M, Horan M, Kulild JC, Baur D. Perioperative Antiplatelet and Anticoagulant Management with Endodontic Microsurgical Techniques. J Endod 2021; 47:1557-1565. [PMID: 34265324 DOI: 10.1016/j.joen.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to review evidence-based recommendations for the safe perioperative management of patients undergoing endodontic microsurgery who are currently taking antiplatelet or anticoagulant medications. Using the PICO (Population, Intervention, Comparison, Outcome) format, the following scientific question was asked: In patients taking anticoagulant or antiplatelet agents, what is the available evidence in the management of endodontic microsurgery? METHODS MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov databases were searched to identify current recommendations regarding the management of antiplatelet and anticoagulant medications in the context of outpatient dental surgical procedures. Additionally, the authors hand searched the bibliographies of all relevant articles, the gray literature, and textbooks. Because of the lack of clinical studies and evidence on this subject, articles and guidelines from other organizations and association position statements were included. RESULTS Because any minor surgery can become a major surgery, the treating doctor needs to best assess the risk of bleeding, especially if the surgery is anticipated to take longer than 45 minutes. Every patient should be stratified on a case-by-case basis. Consultation with the patient's physician is highly recommended. CONCLUSIONS In order to maximize the effects of these medications (to prevent thrombosis) while minimizing the potential risks (procedural hemorrhage), clinicians should be aware of the best available evidence when considering continuation or discontinuation of antiplatelet and anticoagulant agents perioperatively for endodontic microsurgery. Ideally, a joint effort from an expert panel for microsurgery would be warranted.
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Affiliation(s)
- Anita Aminoshariae
- Departments of Endodontics, Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio.
| | - Mark Donaldson
- School of Pharmacy, University of Montana, Missoula, Montana; School of Dentistry, Oregon Health and Sciences University, Portland, Oregon
| | - Michael Horan
- Oral and Maxillofacial Surgery, Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio
| | - James C Kulild
- UKMC Dental School, University of Missouri-Kansas City, Kansas City, Missouri
| | - Dale Baur
- Oral and Maxillofacial Surgery, Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio
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