Bleeding Disorders and Dental Implants: Review and Clinical Indications
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Inclusion and Exclusion Criteria
3. Results
3.1. Congenital Coagulation Disorders (CCDs)
3.2. Antiplatelet-Induced Bleeding Disorders (APBDs)
3.3. Anticoagulant-Induced Bleeding Disorders (ACBD)
4. Discussion
5. Conclusions
Clinical Importance
- Consulting the physician who treat the patient for their bleeding disorder before implant surgery;
- Almost every study included in the present review suggests administering deficiency factor or desmopressin before the surgery in patients with congenital hemostasis disease;
- Do not withdraw antiaggregative therapy for implant surgery, even if dual; only one study suspended the antiaggregative therapy, but it was due to a concomitant anticoagulant therapy. There is no evidence for the beneficial effect of suspending antiaggregative therapy.
- Do not interrupt therapy with dicumarolics. On the contrary, clinicians should check the INR value before implant surgery and treat any bleeding complications with local hemostatic measures.
- When dealing with direct anticoagulants (DAOC) skip only one dose of the drug, the day before;
- Adopt local hemostatic measures at the end of the procedure and in case of postoperative bleeding: compressive hemostasis with gauze soaked in tranexamic acid showed excellent results in both situations. Regardless of the type of bleeding disorder, all authors agreed in suggesting the application of local hemostatic measures at the end of surgery;
- Instruct the patient about the appropriate post-operative measures: soft and cold diet for 2–3 days, avoiding vigorous rinses, physical effort and the supine position, applying gauze for 5 min in case of bleeding. If these are not enough, repeat the application of the gauze soaked with tranexamic acid. Not all articles reported postoperative instructions, but those that did agree with what is reported here.
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
Appendix A
Study Type | Underlying Blood Disease | No. of Implants Inserted for Intervention | Flapless | Prophylaxis | Additional Drug Administered after the Procedure | Local Haemostatic Measurements | Bleeding Complications | |
---|---|---|---|---|---|---|---|---|
Gornitisky et al., 2005 [16] | Case report | Moderate haemophilia A | 3; 2; 1 | Unspecified | Factor VIII; Tranexamic acid per os | Factor VIII; Tranexamic acid per os | Suture | No |
Rosen et al., 2005 [15] | Case report | Moderate haemophilia A | 3; 2; 1 | Unspecified | Unspecified | Unspecified | Unspecified | No |
Neskoromna-Jȩdrzejczak et al., 2018 [17] | Case report | Severe haemophilia B | 2; 2 | No | Recombinant Factor IX | Recombinant Factor IX | Suture | No |
Castellanos-Cosano et al., 2014 [13] | Case report | Severe haemophilia A; HIV; HCV | 3; 2 | No | Antibiotic; Factor VIII (FVIII), Tranexamic acid per os | Antibiotic; Factor VIII (FVIII), Tranexamic acid per os | Unspecified | No |
Fénelon et al., 2017 [20] | Case report | Von Willebrand disease | 1 | Yes | Von Willebrand Factor (vWF) | Von Willebrand Factor (vWF); Antibiotic | Suture; fibrin glue | No |
Kang et al., 2018 [19] | Case report | Von Willebrand disease | 1 | Yes | Desmopressin | none | Unspecified | No |
Sung-Tak Lee et al., 2018 [23] | Case report | Porpora trombocitopenica idiopatica | 1 | Presumably not | none | none | Unspecified | Severe |
Calvo-Guirado et al., 2019 [14] | Case report | Severe haemophilia B | 1 | No | Antibiotic; Factor IX; Tranexamic acid per os | Factor IX; Tranexamic acid per os and rinses | Suture; particulate bone graft and collagen membrane soaked in tranexamic acid; compressive hemostasis with gauze soaked in tranexamic acid | No |
Bacci et al., 2021 [21] | Case report | Von Willebrand disease type 2B | 5 | Yes | Factor VIII + VWF; tranexamic acid | tranexamic acid per os; | Unspecified | No |
Bacci et al., 2021 [12] | Case report | Mild haemophilia A | 1 | Yes | Factor VIII; tranexamic acid | Unspecified | Unspecified | No |
Takashima et al., 2021 [22] | Case report | Von Willebrand disease type 1 | 6 | Unspecified | Factor VIII + VWF | Unspecified | Unspecified | Unspecified |
Kinalsky et al., 2021 [18] | Case report | Haemophilia A | 3; 3 | Yes | Factor VIII; tranexamic acid | no | Suture | Mild |
Study Type | Antithrombotic Treatment | Discontinuation of the Pharmacological Therapy | No. of Procedures | Post-Operative Bleeding Complications | Management of Complications | |
---|---|---|---|---|---|---|
Flanagan et al., 2015 [24] | Case report | Clopidogrel + ASA | No | 1 | 1 | Compressive hemostasis with sponge soaked in tranexamic acid |
Clemm et al., 2015 [28] | Case–control study | Dicumarols (32)/bridging with LMWH (8)/Dabigatran (6)/Rivaroxaban (8)/Apixaban (2)/Antiaggregants (61) | No | 61 (antiaggregants) | 4 (1 antiaggregant; 2 dicumarols e 1 dicumarols bridged with LMWH) | Compressive hemostasis with gauze soaked in tranexamic acid/Compressive hemostasis with gauze soaked in tranexamic acid + additional suture/revision of the wound and electrocoagulation |
Tabrizi et al., 2018 [25] | Case-crossover study | Clopidogrel/ASA | Only in the second session of the study | 41 | / | / |
Rubino et al., 2019 [26] | Retrospective cohort study | ASA/Clopidogrel/Warfarin/DOAC/ASA + clopidogrel /Clopidogrel + warfarin/ASA + clopidogrel + warfarin/ASA + clopidogrel + DOAC/ASA + DOAC/ASA + warfarin + DOAC | Only in 4 cases, after consulting the physician | 218 | 2 (1 in ASA + warfarin; 1 in warfarin) | Cauterization and infiltration with lidocaine |
Kaura et al., 2021 [27] | Prospective cohort study | Clopidogrel/ASA/Clopidogrel + ASA | No | 65 | 1 (in dual therapy) | / |
Manor et al., 2021 [29] | Case–control study | Clopidogrel/ASA/DOAC/Warfarin/Combinations | No | 72 (+121 control group) | 4 (1 warfarin + DOAC; 2 Clopidogrel + ASA; 1 warfarin + clopidogrel); + 7 control group | Suture/Suture + Compressive hemostasis with sponge gauze in tranexamic acid |
Broekema et al., 2021 [30] | Case–control study | Antiaggregants/Dicumarols | No | 8 (+7 control group) | 0 | / |
Buchbender et al., 2021 [31] | Case–control study | Antiaggregants/Dicumarols/DOACs | No | 95 (+100 control group) | 15 | Compressive hemostasis with gauze soaked in tranexamic acid |
Study Type | Anticoagulant Therapy | No. of Patients in the Study | No. of implants | Discontinuation of the Pharmacological Therapy | Flapless | Local Hemostatic Measures | Bleeding Complications | Management of Complications | |
---|---|---|---|---|---|---|---|---|---|
Ferrieri et al., 2007 [8] | Cohort study | Warfarin | 3 | 7 | No | No | Suture + compressive hemostasis for 30 min with gauzed soaked in saline | No | / |
Bacci et al., 2011 [48] | Case–control study | Warfarin | 50 | 159 | No | No | Suture + compressive hemostasis with gauze soaked in tranexamic acid for 30–60 min | 2 | Compressive hemostasis with gauze soaked in tranexamic acid for 1 h |
Miranda et al., 2011 [40] | Case report | Warfarin | 1 | 4 | Bridged with heparin | No | Unspecified | No | / |
Hong et al., 2012 [43] | Cohort study | Warfarin | 1 | 2 | No | Unspecified | “Poncho” of gingival former soaked with tramexamic acid | 1 | Local hemostatic measures and reinforcement of home care instructions |
Broekema et al., 2014 [30] | Case–control study | Antiaggregants/Dicumarols | 7 | Unspecified | No | No | Unspecified | 0 | / |
Clemm et al., 2015 [28] | Case–control study | Dicumarolici (32)/bridging with LMWH (8)/Dabigatran (6)/Rivaroxaban (8)/Apixaban (2)/Antiaggregants (61) | 117 (among them, 61 in therapy with antiaggregants) | Unspecified | No | No | Suture; electrocoagulation | 4 (1 antiaggreganti; 2 dicumarolici e 1 dicumarolici embricato con LMWH) | Compressive hemostasis with gauze soaked in tranexamic acid/Compressive hemostasis with gauze soaked in tranexamic acid + additional suture/revision of the wound and electrocoagulation |
Gomez-Moreno 2016 [49] | Case–control study | Rivaroxaban | 18 | 43 | No | No | Suture + compressive hemostasis with gauze soaked in tranexamic acid | 1 | Compressive hemostasis with gauze soaked in tranexamic acid |
Romero-Ruiz et al., 2015 [41] | Case report | Acenocumarolo | 1 | 12 | No | Yes | Unspecified | No | / |
Gomez-Moreno 2018 [50] | Case–control study | Dabigatran | 29 | 67 | Yes | No | Suture + compressive hemostasis with gauze soaked in tranexamic acid for 30–60 min | 2 | Compressive hemostasis with gauze soaked in tranexamic acid |
Kim et al., 2018 [23] | Case report | Rivaroxaban | 1 | 2 | Yes | No | Suture + compressive hemostasis for 1 h | Yes (3) | Compressive hemostasis with gauze + applying oxidized regenerated cellulose |
Okamoto et al., 2018 [45] | Cohort study | Unspecified | 289 | Unspecified | No | Unspecified | Unspecified | 0 | / |
Gandhi et al., 2019 [42] | Case report | Rivaroxaban (3); Apixaban (1); Dabigatran (1) | 6 | 18 | No | Yes | Unspecified | No | / |
Rubino et al., 2019 [26] | Cohort study | Antiaggrant/Warfarin/DOAC/combinations | 176 | 218 | Only in 4 cases | Unspecified | Unspecified | 2 (1 in ASA + warfarin; 1 in warfarin) | Local hemostatic measures |
Kwak et al., 2019 [46] | Cohort study | Dabigatran (3); Rivaroxaban (3); Apixaban (3) | 8 | Unspecified | Yes: for 24 h in 8 cases; 48 h for 1 case | No | Suture + compressive hemostasis for 1 h | 3 | Compressive hemostasis |
Al Zoman et al., 2013 [39] | Case report | Warfarin | 1 | 1; 1 | No | Yes | Compressive hemostasis | No | / |
Sannino et al., 2020 [47] | Case–control study | Warfarin (40) e rivaroxaban (40) | 80 | 320 | No | No | Bone wax and spongostan in the extraction site + Compressive hemostasis with gauze soaked in tranexamic acid | Gruppo warfarin: 29 mild, 11 moderate; Gruppo rivaroxavan: 37 mild, 3 moderate | Mild: Compressive hemostasis with gauze; moderate: unspecified |
Galletti et al., 2020 [44] | Cohort study | Rivaroxaban | 12 | 57 | Yes (for 24 h) | No | Suture + compressive hemostasis for 30 min (+compressive hemostatis with gauze soaked with tranexamic acid for other 30 min if needed) | 3 | Compressive hemostasis with gauze soaked in tranexamic acid (+electrocauterization and additional sutures, if necessary) |
Manor et al., 2021 [29] | Case–control study | Clopidogrel/ASA/DOAC/Warfarin/Combinations | 72 | Unspecified | No | No | Suture + gelatin sponge + Compressive hemostasis with gauze soaked in tranexamic acid for 20–30 min | 4 (1 warfarin + DOAC; 2 Clopidogrel + ASA; 1 warfarin + clopidogrel); +7 controlli | Suture/suture + compressive hemostasis with gauze soaked in tranexamic acid |
Buchbender et al., 2021 [21] | Case–control study | Antiaggregants/Dicumarols/DOACs | 95 | Unspecified | no | Unspecified | suture + compressive hemostasis with gauze soaked in tranexamic acid | 1 | Compressive hemostasis with gauze soaked in tranexamic acid |
- Search strings for CCDs
- Search strings for APBDs
- Search strings for ACBDs
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Bacci, C.; Schiazzano, C.; Zanon, E.; Stellini, E.; Sbricoli, L. Bleeding Disorders and Dental Implants: Review and Clinical Indications. J. Clin. Med. 2023, 12, 4757. https://doi.org/10.3390/jcm12144757
Bacci C, Schiazzano C, Zanon E, Stellini E, Sbricoli L. Bleeding Disorders and Dental Implants: Review and Clinical Indications. Journal of Clinical Medicine. 2023; 12(14):4757. https://doi.org/10.3390/jcm12144757
Chicago/Turabian StyleBacci, Christian, Claudia Schiazzano, Ezio Zanon, Edoardo Stellini, and Luca Sbricoli. 2023. "Bleeding Disorders and Dental Implants: Review and Clinical Indications" Journal of Clinical Medicine 12, no. 14: 4757. https://doi.org/10.3390/jcm12144757