Top

Clinical Oral Investigations

Published in:

01-03-2021 | Original Article

Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: a randomized clinical trial

Authors: Ylenia Brancaccio, Alessandro Antonelli, Selene Barone, Francesco Bennardo, Leonzio Fortunato, Amerigo Giudice

Published in: Clinical Oral Investigations | Issue 3/2021

Abstract

Objectives

The purpose of this study was to evaluate clinical efficacy of four different local hemostatics in patients taking oral antiplatelet therapy, after multiple dental extractions without discontinuing drugs.

Materials and methods

Study sample included 102 patients (mean age 64.1 ± 17.4 years) in treatment with oral antiplatelet agents needing multiple dental extractions. After surgery, the sockets were randomly sealing with suture alone (control group), hemostatic plug (HEM), advanced platelet-rich fibrin (A-PRF+), and leukocyte-platelet-rich fibrin (L-PRF). Primary outcomes were post-operative bleeding, wound healing index, and possible complications. Secondary outcomes were correlation between primary outcomes and patient’s comorbidities and voluptuous habits. Descriptive statistics, bivariate comparisons, and logistic regression analysis were performed (p < 0.05).

Results

Both A-PRF+ and L-PRF showed a reduced bleeding risk when compared with suture alone (OR = 0.09, p = 0.001 for A-PRF+; OR = 0.09, p = 0.005 for L-PRF). Only L-PRF showed a reduced risk for incomplete wound healing when compared with the control site (OR = 0.43, p = 0.019). Patients affected by hypertension (OR 3.91, p = 0.015) and diabetes (OR 3.24, p = 0.026) had the highest bleeding risk. Smoking (OR 4.30, p = 0.016) and diabetes (OR 3.79, p = 0.007) interfered with healing process.

Conclusion

L-PRF and A-PRF represent a valid alternative to the traditional hemostatics, reducing post-surgical bleeding and promoting wound healing.

Clinical relevance

In patients taking antiplatelet drugs, different local hemostatics are useful to control potential post-operative bleeding and to favor wound healing. However, comorbidities and voluptuous habits may increase bleeding risk, interfering with healing process.

Kämmerer PW, Frerich B, Liese J, Schiegnitz E, Al-Nawas B (2015) Oral surgery during therapy with anticoagulants-a systematic review. Clin Oral Investig. 19(2):171–180CrossRef

Hanken H, Gröbe A, Heiland M et al (2016) Postoperative bleeding risk for oral surgery under continued rivaroxaban anticoagulant therapy. Clin Oral Investig. 20(6):1279–1282CrossRef

Bajkin BV, Urosevic IM, Stankov KM, Petrovic BB, Bajkin IA (2015) Dental extractions and risk of bleeding in patients taking single and dual antiplatelet treatment. Br J Oral Maxillofac Surg. 53(1):39–43CrossRef

Dudek D, Kuliczkowski W, Kaczmarski J et al (2015) Response to dual antiplatelet therapy does not impact bleeding risks in patients undergoing oral surgery after acute coronary syndromes. Cardiology. 132(2):119–123CrossRef

Katzung BG. Basic and clinical pharmacology. Mc Graw-Hill Education. 2018, 14^th edition.

Bourantas CV, Garcia-Garcia HM, Farooq V, Maehara A, Xu K, Genereux P, Diletti R, Muramatsu T, Fahy M, Weisz G, Stone GW, Serruys PW (2013) Clinical and angiographic characteristics of patients likely to have vulnerable plaques: analysis from the PROSPECT study. JACC Cardiovasc Imaging. 6(12):1263–1272CrossRef

Wahl MJ (1998) Dental surgery in anticoagulated patients. Arch Intern Med. 158(15):1610–1616CrossRef

Napeñas JJ, Hong CH, Brennan MT, Furney SL, Fox PC, Lockhart PB (2009) The frequency of bleeding complications after invasive dental treatment in patients receiving single and dual antiplatelet therapy. J Am Dent Assoc. 140(6):690–695CrossRef

Nathwani S, Martin K (2016) Exodontia in dual antiplatelet therapy: the evidence. Br Dent J. 220(5):235–238CrossRef

10.

Salam S, Yusuf H, Milosevic A (2007) Bleeding after dental extractions in patients taking warfarin. Br J Oral Maxillofac Surg. 45(6):463–466CrossRef

11.

Miura K, Matsumura K, Nakamura Y, Kurokawa H, Kajiyama M, Takata Y (2000) Suppression of cardiac sympathetic nervous system during dental surgery in hypertensive patients. Hypertens Res. 23(3):207–212CrossRef

12.

Knapp JF, Fiori T (1984) Oral hemorrhage associated with periodontal surgery and hypertensive crisis. J. Am Dent Assoc. 108(1):49–51CrossRef

13.

Mozzati M, Gallesio G, di Romana S, Bergamasco L, Pol R (2014) Efficacy of plasma-rich Growth factor in the healing of postextraction sockets in patients affected by insulin-dependent diabetes mellitus. J Oral Maxillofac Surg. 72(3):456–462CrossRef

14.

Vettori E, Costantinides F, Nicolin V, Rizzo R, Perinetti G, Maglione M, Di Lenarda R. Factors influencing the onset of intra- and post-operative complications following tooth exodontia: retrospective survey on 1701 patients. Antibiotics(Basel). 2019; 8(4): 264.

15.

Ockerman A, Miclotte I, Vanhaverbeke M et al (2019) Local haemostatic measures after tooth removal in patients on antithrombotic therapy: a systematic review. Clin Oral Investig. 23(4):1695–1708CrossRef

16.

Sarkar S, Prashanth NT, Shobha ES, Rangan V, Nikhila G (2019) Efficacy of platelet rich fibrin versus chitosan as a hemostatic agent following dental extraction in patients on antiplatelet therapy. J Oral Biol Craniofac Res. 9(4):336–339CrossRef

17.

Pippi R, Santoro M, Cafolla A (2017) The use of a chitosan-derived haemostatic agent for postextraction bleeding control in patients on antiplatelet treatment. Journal of Oral and Maxillofacial Surgery. 75(6):1118–1123CrossRef

18.

Marenzi G, Riccitiello F, Tia M, di Lauro A, Sammartino G (2015) Influence of leukocyte- and platelet-rich fibrin (L-PRF) in the healing of simple postextraction sockets: a split-mouth study. Biomed Res Int. 2015:369273CrossRef

19.

Gasparro R, Qorri E, Valletta A, Masucci M, Sammartino P, Amato A, Marenzi G (2018) Non-transfusional hemocomponents: from biology to the clinic—a literature review. Bioengineering (Basel). 5(2):27CrossRef

20.

Miron RJ, Zucchelli G, Pikos MA, et al. Use of platelet-rich fibrin in regenerative dentistry: a systematic review. Clin Oral Investig. 2017;21(6):1913–1927.

21.

Fujioka-Kobayashi M, Miron RJ, Hernandez M, Kandalam U, Zhang Y, Choukroun J (2017) Optimized platelet-rich fibrin with the low-speed concept: growth factor release, biocompatibility, and cellular response. J Periodontol. 88(1):112–121CrossRef

22.

Farina R, Trombelli L (2011 Sep) Wound healing of extraction sockets. Endodon Top. 25(1):16–43CrossRef

23.

Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P (2017) CONSORT statement for randomized trials of nonpharmacologic treatments: A 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med 167(1):40–47

24.

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(1):27–323

25.

Patrono C, Bachmann F, Baigent C et al (2004) Expert consensus document on the use of antiplatelet agents. The Task Force on the Use of Antiplatelet Agents in Patients with Atherosclerotic Cardiovascular Disease of the European Society of Cardiology. European Heart Journal. 25(2):166–181CrossRef

26.

Li L, Zhang W, Yang Y, Zhao L, Zhou X, Zhang J (2019) Dental management of patient with dual antiplatelet therapy: a meta-analysis. Clin Oral Investig. 23(4):1615–1623CrossRef

27.

Miclotte I, Vanhaverbeke M, Agbaje JO et al (2017) Pragmatic approach to manage new oral anticoagulants in patients undergoing dental extractions: a prospective case-control study. Clin Oral Investig. 21(7):2183–2188CrossRef

28.

Sammartino G, Dohan Ehrenfest DM, Carile F, Tia M, Bucci P (2011) Prevention of hemorrhagic complications after dental extractions into open heart surgery patients under anticoagulant therapy: the use of leukocyte- and platelet-rich fibrin. J Oral Implantol. 37(6):681–690CrossRef

29.

Morimoto Y, Niwa H, Minematsu K (2008) Hemostatic management of tooth extractions in patients on oral antithrombotic therapy. J Oral Maxillofac Surg. 66(1):51–57CrossRef

30.

Sadeghi-Ghahrody M, Yousefi-Malekshah SH, Karimi-Sari H, Yazdanpanah H, Rezaee-Zavareh MS, Yavarahmadi M (2016) Bleeding after tooth extraction in patients taking aspirin and clopidogrel (Plavix®) compared with healthy controls. Br J Oral Maxillofac Surg. 54(5):568–572CrossRef

31.

Halfpenny W, Fraser JS, Adlam DM (2001) Comparison of 2 hemostatic agents for the prevention of postextraction hemorrhage in patients on anticoagulants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 92(3):257–259CrossRef

32.

Giudice A, Esposito M, Bennardo F, Brancaccio Y, Buti J, Fortunato L (2019) Dental extractions for patients on oral antiplatelet: a within-person randomised controlled trial comparing haemostatic plugs, advanced-platelet-rich fibrin (A-PRF+) plugs, leukocyte- and platelet-rich fibrin (L-PRF) plugs and suturing alone. Int J Oral Implantol (New Malden). 12(1):77–87

33.

Dohan Ehrenfest DM, Pinto NR, Pereda A et al (2018) The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Platelets. 29(2):171–184CrossRef

34.

Gasparro R, Sammartino G, Mariniello M, di Lauro AE, Spagnuolo G, Marenzi G (2020) Treatment of periodontal pockets at the distal aspect of mandibular second molar after surgical removal of impacted third molar and application of L-PRF: a split-mouth randomized clinical trial. Quintessence Int. 51(3):204–211PubMed

35.

Tang M, Yu C, Hu P, Wang C, Sheng J, Ma S (2018) Risk factors for bleeding after dental extractions in patients over 60 years of age who are taking antiplatelet drugs. Br J Oral Maxillofac Surg. 56(9):854–858CrossRef

36.

Orcajo B, Muruzabal F, Isasmendi C et al (2011) The use of plasma rich in growth factor (PRGF-Endoret) in the treatment of a severe mal perforant ulcer in the foot of a person with diabetes. Diabetes Res Clin Pract. 93(2):e65–e67CrossRef

37.

Silvestre FJ, Salvador-Martínez I, Bautista D, Silvestre-Rangil J (2011) Clinical study of hemodynamic changes during extraction in controlled hypertensive patients. Med Oral Patol Oral Cir Bucal. 16(3):e354–e358CrossRef

38.

Meechan JG, Macgregor ID, Rogers SN, Hobson RS, Bate JP, Dennison M (1988) The effect of smoking on immediate post-extraction socket filling with blood and on the incidence of painful socket. The British Journal of Oral & Maxillofacial Surgery. 26(5):402–409CrossRef

39.

Nusair YM, Younis MHA (2007) Prevalence, clinical picture, and risk factors of dry socket in a Jordanian dental teaching center. J Contemp Dent Pract. 8(3):53–63CrossRef

40.

Al-Belasy FA (2004) The relationship of “shisha” (water pipe) smoking to postextraction dry socket. J Oral Maxillofac Surg. 62(1):10–14CrossRef

41.

Mudali V, Mahomed O (2016) Incidence and predisposing factors for dry socket following extraction of permanent teeth at a regional hospital in Kwa-Zulu Natal. South African Dental 41. Journal. 71(4):166–169

42.

Cryer PE, Haymond MW, Santiago JV, Shah SD (1976) Norepinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic events. N Engl J Med. 295(11):573–577CrossRef

Title: Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: a randomized clinical trial
Authors: Ylenia Brancaccio
Alessandro Antonelli
Selene Barone
Francesco Bennardo
Leonzio Fortunato
Amerigo Giudice
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 3/2021
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-020-03420-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: a randomized clinical trial

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 3/2021

The effect of radiotherapy delivery time and obturation materials on the fracture resistance of mandibular premolars

Subgingival microflora in adolescent females with polycystic ovary syndrome and its association with oral hygiene, gingivitis, and selected metabolic and hormonal parameters

Efficacy of Er,Cr:YSGG laser–assisted delivery of topical anesthesia in the oral mucosa

Symmetry of palatal shape during the first year of life in healthy infants

Routine panendoscopy in oral squamous cell cancer patients: mandatory or facultative?

Effect of gastric acids on surface topography and bending properties of esthetic coated nickel-titanium orthodontic archwires