• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Doctoral Thesis
DOI
https://doi.org/10.11606/T.23.2015.tde-16042015-100208
Document
Author
Full name
Frederico Buhatem Medeiros
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2015
Supervisor
Committee
Ortega, Karem Lopez (President)
Neves, Itamara Lucia Itagiba
Rezende, Nathalie Pepe Medeiros de
Santos, Paulo Sergio da Silva
Serrano Junior, Carlos Vicente
Title in Portuguese
Extração dentária em pacientes com doença arterial coronariana em terapia antiplaquetária dual
Keywords in Portuguese
Cirurgia Bucal
Doenças cardiovasculares - Odontologia
Extração dentária
Hemorragia Bucal - controle
Abstract in Portuguese
A terapia antiplaquetária dual, cada vez mais tem sido utilizada como uma forma de abordagem terapêutica em pacientes com doença arterial coronariana (DAC), e principalmente em portadores de stents farmacológicos. Drogas antiplaquetárias, quando associadas, aumentam o risco de sangramento, isto faz com que muitos profissionais recomendem a suspensão da medicação antes de qualquer procedimento cirúrgico odontológico, entretanto, a suspensão desta terapia expõe os pacientes portadores de stent coronariano à riscos adversos de eventos trombóticos. Por consequência, permanece desafiador e controverso o manejo odontológico cirúrgico de pacientes coronariopatas em uso de terapia antiplaquetária dual. Diante disso, foi realizado uma pesquisa clínica com o objetivo de avaliar quantitativamente o sangramento trans-operatório de extração dentária de pacientes em uso de terapia antiplaquetária dual (AAS + clopidogrel). Este estudo caso-controle, incluiu 38 pacientes com DAC sob terapia antiplaquetária dual com AAS e clopidogrel (grupo de estudo = GE) e 35 pacientes com doença cardiovascular sem nenhum uso de medicação antiplaquetária (grupo controle = GC), ambos com indicação de extração dentária. No dia do procedimento cirúrgico, foi realizado exame de hemograma completo, coagulograma e agregação plaquetária por turbidimetria, utilizando agonistas de adrenalina, adenosina difosfato e ácido araquidônico, no GC e pelo Verifynow no GE, e no, trans-operatório mensurada a quantidade de sangramento por meio da coleta de sangue aspirado. O GE demonstrou um sangramento mais intenso do que o GC, estatisticamente significante, com média de quantidade de sangramento 1,0 e 0,6 ml/min, respectivamente. Métodos hemostáticos locais foram suficientes para controlar o sangramento e em nenhum dos casos houve episódios de hemorragia no trans e/ou pós-operatório. A agregação plaquetária, no GC, apresentou características de hipoagregabilidade, sendo estatisticamente significante apenas o efeito da adrenalina na quantidade de sangramento ocorrido durante o procedimento cirúrgico (p-valor 0,018). No GE, a agregação plaquetária não demonstrou resultados estatísticos significantes, no entanto, foram encontrados 11 (28,94%) pacientes considerados resistentes à terapia com ácido acetilsalicílico com valores de ARU entre 550 a 700 e 12 (31,57%) pacientes considerados não respondedores ao clopidogrel, com valores de PRU acima de 230. De acordo com os nossos resultados, pacientes portadores de DAC, em uso de terapia antiplaquetária dual, AAS + clopidogrel, apresentam maior quantidade de sangramento, mas que pode ser controlado com medidas hemostáticas locais, não sendo necessária a suspensão da terapia antiplaquetária para extração de até três dentes.
Title in English
Tooth extraction in patients with coronary artery disease and on dual-antiplatelet therapy
Keywords in English
Cardiovasculares diseases - dentistry
Oral bleeding - control
Surgery oral
Tooth extraction
Abstract in English
Dual-antiplatelet therapy has been used as a therapeutic approach for patients with coronary artery disease (CAD), mainly for those bearing pharmacological stents. The association of antiplatelet a drug increases the risk of bleeding, and for that reason many professionals withdraw the medications prior to any dental surgical procedure. Though, when this therapy is discontinued, patients with coronary stent are exposed to adverse risks of thrombotic events. As a consequence, dental surgical management of patients with CAD and on dual-antiplatelet therapy remains challenging and controversial. On this basis, a clinical research was developed with the aim to evaluate the amount of bleeding that occurs during the intraoperative period of tooth extraction procedures in patients with CAD who are either undergoing dual-antiplatelet therapy (AAS + clopidogrel). This case-control study comprised 38 patients diagnosed with CAD and on dual-antiplatelet therapy, AAS and clopidogrel (study group = SG) and 35 patients with cardiovascular disease, but not on antiplatelet therapy (control group = CG), both requiring tooth extraction. A complete blood count, blood clotting test and platelet aggregation by turbidimetry using epinephrine agonists, adenosine diphosphate and arachidonic acid were carried out on the day of the operation in the CG and using the Verifynow in the SG. The amount of bleeding was measured during the intraoperative period by means of aspirated blood collection. The statistically significant mean volumes of bleeding were 1.0 e 0.6 mL/min for both SG and CG, respectively. The SG showed a more intense bleeding compared to the CG. Local hemostatic measures showed to suffice for controlling possible bleeding problems and in none of the procedures there were intra-operative and/ or post-operative bleeding episodes. Platelet aggregation, for the CG, demonstrated platelet hypoagregability, and only the epinephrine effect was statistically significant for the amount of bleeding during the surgical procedure (p-value 0.018). In the SG, platelet aggregation has not shown statistically significant values. Nonetheless, 11 patients (28.94%) were resistant to acetylsalicylic acid demonstrating ARU values between 550 and 700, 12 patients (31.57%) have not responded to clopidogrel therapy, and the PRU values were above 230. According to the results of this study, individuals with CAD and on dual-antiplatelet therapy (AAS + Clopidogrel), demonstrated a greater amount of bleeding, which can be minimized by using local haemeostatics and not suspending the antiplatelet drug for tooth extraction.
 
WARNING - Viewing this document is conditioned on your acceptance of the following terms of use:
This document is only for private use for research and teaching activities. Reproduction for commercial use is forbidden. This rights cover the whole data about this document as well as its contents. Any uses or copies of this document in whole or in part must include the author's name.
Publishing Date
2015-05-06
 
WARNING: Learn what derived works are clicking here.
All rights of the thesis/dissertation are from the authors
CeTI-SC/STI
Digital Library of Theses and Dissertations of USP. Copyright © 2001-2024. All rights reserved.