Riesgo de hemorragia postquirúrgica en pacientes bajo tratamiento antitrombótico sometidos a cirugía oralRevisión Sistemática y Metaanálisis.

  1. Julio Villanueva 1
  2. Diego Vergara 1
  3. Lorena Núñez 1
  4. Gabriel Zamorano 1
  5. Sebastián Zapata 1
  6. Josefina Salazar 1
  7. Ana Alarcón 1
  8. Rosa Rojo 2
  9. Stefan Domancic 1
  10. Nicolás Yanine 1
  11. Ignacio Araya 1
  1. 1 Universidad de Chile
    info

    Universidad de Chile

    Santiago de Chile, Chile

    ROR https://ror.org/047gc3g35

  2. 2 Universidad Rey Juan Carlos
    info

    Universidad Rey Juan Carlos

    Madrid, España

    ROR https://ror.org/01v5cv687

Revista:
Revista clínica de periodoncia, implantología y rehabilitación oral

ISSN: 0719-0107

Año de publicación: 2018

Volumen: 11

Número: 2

Páginas: 121-127

Tipo: Artículo

DOI: 10.4067/S0719-01072018000200121 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Revista clínica de periodoncia, implantología y rehabilitación oral

Objetivos de desarrollo sostenible

Resumen

RESUMEN: Introducción: el objetivo de esta revisión fue determinar el riesgo de hemorragia postoperatoria en pacientes con tratamiento anticoagulante oral (TACO) sometidos a cirugía oral que no suspenden su tratamiento comparado con quienes lo modifican o suspenden. Materiales y métodos: se realizó una búsqueda en CENTRAL, Medline y EMBASE, junto con una revisión manual de revistas especializadas y resúmenes de la IADR. Dos revisores realizaron la selección de estudios, evaluación de riesgo de sesgo y extracción de datos de forma independiente. Se seleccionaron los ensayos clínicos aleatorizados que miden la aparición de hemorragias en pacientes sometidos a procedimientos quirúrgicos orales con TACO en comparación con un grupo que interrumpió o modificó su terapia. Resultados: Solo 5 estudios cumplieron los criterios de inclusión (549 pacientes). El metanálisis mostró que el mantenimiento de la TACO no aumenta el riesgo de hemorragia postoperatoria (riesgo relativo: 1,41 [0,93 - 2,16], IC del 95% p = 0,11) en comparación con la interrupción del tratamiento. Conclusión: Aunque se encontró una mayor cantidad de hemorragia postoperatoria en pacientes con TACO comparado con quienes lo interrumpieron o modificaron, esta diferencia no fue estadística ni clínicamente significativa. Por lo tanto, TACO no debe suspenderse en pacientes sometidos a cirugía oral.

Referencias bibliográficas

  • Nematullah, A,Alabousi, A,Blanas, N,Douketis, JD,Sutherland, SE. (2009). Dental surgery for patients on anticoagulant therapy with warfarin: a systematic review and meta-analysis. J Can Dent Assoc. 75. 41
  • Wadelius, M,Pirmohamed, M. (2007). Pharmacogenetics of warfarin: current status and future challenges. Pharmacogenomics J. 7. 99-111
  • Lip, GYH,Lane, DA. (2015). Stroke prevention in atrial fibrillation: a systematic review. JAMA. 313. 1950
  • Manolopoulos, VG,Ragia, G,Tavridou, A. (2010). Pharmacogenetics of coumarinic oral anticoagulants. Pharmacogenomics. 11. 493
  • Berkovits, A,Aizman, A,Zúñiga, P,Pereira, J,Mezzano, D. (2011). Nuevos anticoagulantes orales. Rev Méd Chile. 139. 1347
  • Doonquah, L,Mitchell, AD. (2012). Oral surgery for patients on anticoagulant therapy: current thoughts on patient management. Dent Clin North Am. 56. 25-41
  • Prandoni, P,Noventa, F,Ghirarduzzi, A,Pengo, V,Bernardi, E,Pesavento, R. (2007). The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica. 92. 199-205
  • Toscano, LCNJ,Mumford, CJ,Turner, CB. (2006). Dental management of the anticoagulated patient. Clinical update. 28. 9-10
  • Pedemonte T, C,Montini, C,Castellón, L. (2005). Manejo de pacientes en tratamiento con anticoagulantes orales previo a cirugía oral. Rev Odontológica Mex. 9. 171
  • Soares, ECS,Costa, FWG,Bezerra, TP,Nogueira, CBP,de Barros Silva, PG,Batista, SHB. (2015). Postoperative hemostatic efficacy of gauze soaked in tranexamic acid, fibrin sponge, and dry gauze compression following dental extractions in anticoagulated patients with cardiovascular disease: a prospective, randomized study. Oral Maxillofac Surg. 19. 209
  • Weltman, NJ,Al-Attar, Y,Cheung, J,Duncan, DP,Katchky, A,Azarpazhooh, A. (2015). Management of dental extractions in patients taking warfarin as anticoagulant treatment: a systematic review. J Can Dent Assoc. 81. 20
  • Büller, HR,Agnelli, G,Hull, RD,Hyers, TM,Prins, MH,Raskob, GE. (2004). Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 126. 401
  • Salem, DN,Stein, PD,Al-Ahmad, A,Bussey, HI,Horstkotte, D,Miller, N. (2004). Antithrombotic therapy in valvular heart disease--native and prosthetic: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 126. 457
  • Nishimura, RA,Otto, CM,Bonow, RO,Carabello, BA,Erwin, JP,Guyton, RA. (2014). AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 148. 1-132
  • Murphy, J,Twohig, E,McWilliams, SR. (2010). Dentists’ approach to patients on anti-platelet agents and warfarin: a survey of practice. J Ir Dent Assoc. 56. 28-31
  • Dewan, K,Vithlani, V,Patel, N,Warren, K. (2012). A study to assess management of patients on warfarin by general dental practitioners (GDPS) in the west midlands. Dental Update. 39. 578
  • Moher, D,Liberati, A,Tetzlaff, J,Altman, DG. (2009). The PRISMA Group Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 6.
  • Liberati, A,Altman, DG,Tetzlaff, J,Mulrow, C,Gøtzsche, PC,Ioannidis, JPA. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 62. 1-34
  • Higgins, JP,Green, S. (2008). Cochrane handbook for systematic reviews of interventions. Wiley Online Library.
  • (2014). Review Manager (RevMan) [Computer program]. Version 5.3. The Nordic Cochrane Centre, The Cochrane Collaboration. Copenhagen.
  • Guyatt GH, OA,Vist, GE,Kunz, R,Falck-Ytter, Y,Alonso-Coello, P,Schünemann, HJ. (2008). GRADE Working Group GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 336. 924
  • Al-Mubarak, S,Al-Ali, N,Abou-Rass, M,Al-Sohail, A,Robert, A,Al-Zoman, K. (2007). Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy. Br Dent J. 203.
  • Campbell, JH,Alvarado, F,Murray, RA. (2000). Anticoagulation and minor oral surgery: should the anticoagulation regimen be altered?. J Oral Maxillofac Surg. 58. 131
  • Cannon, PD,Dharmar, VT. (2003). Minor oral surgical procedures in patients on oral anticoagulants--a controlled study. Aust Dent J. 48. 115
  • Evans, IL,Sayers, MS,Gibbons, AJ,Price, G,Snooks, H,Sugar, AW. (2002). Can warfarin be continued during dental extraction? Results of a randomized controlled trial. Br J Oral Maxillofac Surg. 40. 248
  • Sacco, R,Sacco, M,Carpenedo, M,Mannucci, PM. (2007). Oral surgery in patients on oral anticoagulant therapy: a randomized comparison of different intensity targets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 104. 18-21
  • Al-Mubarak, S,Rass, MA,Alsuwyed, A,Alabdulaaly, A,Ciancio, S. (2006). Thromboembolic risk and bleeding in patients maintaining or stopping oral anticoagulant therapy during dental extraction. J Thromb Haemost JTH. 4. 689
  • Sacco, R,Sacco, M,Carpenedo, M,Moia, M. (2006). Oral surgery in patients on oral anticoagulant therapy: a randomized comparison of different INR targets. J Thromb Haemost JTH. 4. 688
  • Evans, IL,Sayers, MS,Gibbons, AJ,Price, G,Snooks, H,Sugar, AW. (2002). Can warfarin be continued during dental extraction? Results of a randomised controlled trial. Br J Oral Maxillofac Surg. 40. 248
  • Sen, P,Sen, R. (2003). Re: Sugar AW et al. Can warfarin be continued during dental extraction? Results of a randomised controlled trial. Br J Oral Maxillofac Surg. 41. 132
  • Bajkin, BV,Popovic, SL,Selakovic, SDJ. (2009). Randomized, prospective trial comparing bridging therapy using low-molecular-weight heparin with maintenance of oral anticoagulation during extraction of teeth. J Oral Maxillofac Surg. 67. 990
  • Bailey, BM,Fordyce, AM. (1983). Complications of dental extractions in patients receiving warfarin anticoagulant therapy. A controlled clinical trial. Br Dent J. 155. 308
  • Souto, JC,Oliver, A,Zuazu-Jausoro, I,Vives, A,Fontcuberta, J. (1996). Oral surgery in anticoagulated patients without reducing the dose of oral anticoagulant: a prospective randomized study. J Oral Maxillofac Surg. 54. 27-32
  • Borea, G,Montebugnoli, L,Capuzzi, P,Magelli, C. (1993). Tranexamic acid as a mouthwash in anticoagulant-treated patients undergoing oral surgery. An alternative method to discontinuing anticoagulant therapy. Oral Surg Oral Med Oral Pathol. 75. 29-31
  • Wahl, MJ,Howell, J. (1996). Altering anticoagulation therapy: a survey of physicians. J Am Dent Assoc. 127. 625-633
  • Kamien, M. (2006). Remove the tooth, but don’t stop the warfarin. Aust Fam Physician. 35. 233