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

    Universidad de Chile

    Santiago de Chile, Chile

    ROR https://ror.org/047gc3g35

  2. 2 Universidad Rey Juan Carlos

    Universidad Rey Juan Carlos

    Madrid, España

    ROR https://ror.org/01v5cv687

Revista clínica de periodoncia, implantología y rehabilitación oral

ISSN: 0719-0107

Year of publication: 2018

Volume: 11

Issue: 2

Pages: 121-127

Type: Article

DOI: 10.4067/S0719-01072018000200121 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Revista clínica de periodoncia, implantología y rehabilitación oral


ABSTRACT: Introduction: This systematic review aims to determine the postoperative bleeding risk in patients on oral anticoagulant therapy (OAT) undergoing oral surgical procedures when continuing with the treatment, compared with those modifying or discontinuing the treatment. Materials and methods: A search was performed using CENTRAL, Medline and EMBASE, in conjunction with a manual review of indexes of specialized journals and abstracts of the IADR. Study selection, assessments of risk of bias and data extraction were performed independently by 2 reviewers. Randomized clinical trials measuring the occurrence of bleeding in patients on OAT undergoing oral surgical procedures compared with a group discontinuing or modifying their therapy were selected. Results: A total of 5 studies were included based on inclusion criteria (549 patients). The meta-analysis showed that the maintenance of OAT does not increases the risk of postoperative bleeding (relative risk [RR] 1.41 [0.93 - 2.16]; 95% CI p= 0,11) compared with the discontinuation of therapy. Conclusion: Although a larger quantity of oral postoperative bleeding episodes were found in patients continuing with OAT compared with patients discontinuing or modifying their therapy, this difference was neither statistically nor clinically significant. Therefore, OAT should not be discontinued in patients undergoing oral surgery.

Bibliographic References

  • 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