Manejo da extração dentária em pacientes com tratamento antiplaquetário: Revisão da literatura
DOI:
https://doi.org/10.33448/rsd-v14i1.48033Palavras-chave:
Extrações dentárias, Terapia antiplaquetária, Controle de sangramento, Medidas hemostáticas, Protocolos clínicos.Resumo
Objetivo: Detalhar o tratamento odontológico correto para pacientes que recebem terapia antiplaquetária durante extrações dentárias, examinando a literatura científica para definir protocolos hemostáticos e ações que reduzam os riscos de sangramento e eventos tromboembólicos. Metodologia: Foi realizada uma análise rigorosa da literatura sobre tratamento cirúrgico em pacientes que recebem terapia antiplaquetária, examinando pesquisas publicadas nos últimos anos. Foram analisados os protocolos comumente utilizados, as estratégias clínicas para descontinuar ou manter a medicação e as técnicas hemostáticas utilizadas. Resultados: Os resultados destacam duas estratégias principais: a descontinuação e a persistência da terapia antiplaquetária. A pesquisa indica que a interrupção do tratamento pode diminuir o risco de sangramento, mas aumenta significativamente o risco de eventos tromboembólicos, como infarto do miocárdio ou acidente vascular cerebral. Por outro lado, a manutenção da terapia antiplaquetária, em combinação com medidas hemostáticas locais, como suturas, ácido tranexâmico e esponjas de colágeno, facilita o gerenciamento eficiente do sangramento pós-operatório, sem diferença perceptível em comparação com os pacientes que interrompem o tratamento. Conclusões: É comum manter a terapia antiplaquetária durante intervenções odontológicas menores, como extrações, desde que sejam usadas as medidas hemostáticas corretas. Essa abordagem reduz os riscos tromboembólicos e facilita o controle eficaz do sangramento.
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Referências
Akhlaghi, F., Khaheshi, I., Amirhassani, S., & Tabrizi, R. (2017). Do antiplatelet drugs increase the risk of bleeding after tooth extraction? A case-crossover study. International journal of oral and maxillofacial surgery, 46(11), 1475–1478. https://doi.org/10.1016/j.ijom.2017.06.002
Amano, H., Saito, D., Yabe, T., Okubo, R., Toda, M., & Ikeda, T. (2017). Efficacy and Safety of Triple Therapy and Dual Therapy With Direct Oral Anticoagulants Compared to Warfarin. International heart journal, 58(4), 570–576. https://doi.org/10.1536/ihj.16-381
Anima. (2014). Manual revisão bibliográfica sistemática integrativa: a pesquisa baseada em evidências. Grupo Anima. https://biblioteca.cofen.gov.br/wp-content/uploads/2019/06/manual_revisao_bibliografica-sistematica-integrativa.pdf.
Borges, J. M. D. M., de Carvalho, F. O., Gomes, I. A., Rosa, M. B., & Sousa, A. C. S. (2018). Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?. Therapeutics and clinical risk management, 14, 1887–1895. https://doi.org/10.2147/TCRM.S172591
Brancaccio, Y., Antonelli, A., Barone, S., Bennardo, F., Fortunato, L., & Giudice, A. (2021). Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: a randomized clinical trial. Clinical oral investigations, 25(3), 1159–1167. https://doi.org/10.1007/s00784-020-03420-3
Buchbender, M., Schlee, N., Kesting, M. R., Grimm, J., Fehlhofer, J., & Rau, A. (2021). A prospective comparative study to assess the risk of postoperative bleeding after dental surgery while on medication with direct oral anticoagulants, antiplatelet agents, or vitamin K antagonists. BMC oral health, 21(1), 504. https://doi.org/10.1186/s12903-021-01868-7
Buhatem Medeiros, F., Pepe Medeiros de Rezende, N., Bertoldi Franco, J., Porrio de Andrade, A. C., Timerman, L., Gallottini, M., Itagiba Neves, I. L., & Ortega, K. L. (2017). Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy. International journal of oral and maxillofacial surgery, 46(9), 1151–1157. https://doi.org/10.1016/j.ijom.2017.05.013
Calcia, T. B. B., Oballe, H. J. R., de Oliveira Silva, A. M., Friedrich, S. A., & Muniz, F. W. M. G. (2021). Is alteration in single drug anticoagulant/antiplatelet regimen necessary in patients who need minor oral surgery? A systematic review with meta-analysis. Clinical oral investigations, 25(6), 3369–3381. https://doi.org/10.1007/s00784-021-03882-z
Crossetti, M. G. M. (2012). Revisión integrativa de la investigación en enfermería, el rigor científico que se le exige. Rev. Gaúcha Enferm. 33 (2): 8-9. 10) https://doi.org/10.1590/S1983-14472012000200002
Dinkova, A. S., Atanasov, D. T., & Vladimirova-Kitova, L. G. (2017). Discontinuation of Oral Antiplatelet Agents before Dental Extraction - Necessity or Myth?. Folia medica, 59(3), 336–343. https://doi.org/10.1515/folmed-2017-0043
Doganay, O., Atalay, B., Karadag, E., Aga, U., & Tugrul, M. (2018). Bleeding frequency of patients taking ticagrelor, aspirin, clopidogrel, and dual antiplatelet therapy after tooth extraction and minor oral surgery. Journal of the American Dental Association (1939), 149(2), 132–138. https://doi.org/10.1016/j.adaj.2017.09.052
Eapen, B. V., Baig, M. F., & Avinash, S. (2017). An Assessment of the Incidence of Prolonged Postoperative Bleeding After Dental Extraction Among Patients on Uninterrupted Low Dose Aspirin Therapy and to Evaluate the Need to Stop Such Medication Prior to Dental Extractions. Journal of maxillofacial and oral surgery, 16(1), 48–52. https://doi.org/10.1007/s12663-016-0912-8
Gaballah, K., & Hassan, M. (2022). Knowledge and Practice of Dentists Managing Patients on Antithrombotic Medications: A Cross-Sectional Survey. European journal of dentistry, 10.1055/s-0041-1739436. Advance online publication. https://doi.org/10.1055/s-0041-1739436
Gupta, R., Dugal, A., Sane, V. D., Hiwarkar, S., Khandelwal, S., & Iyengar, A. (2018). Effect of Low-Dose Aspirin on Bleeding Following Exodontia: A Prospective Clinical Study. Journal of maxillofacial and oral surgery, 17(3), 350–355. https://doi.org/10.1007/s12663-017-1034-7
Huang, J., Liu, J., Shi, H., Wu, J., Liu, J., & Pan, J. (2022). Risk factors for bleeding after dental extractions in patients receiving antithrombotic drugs - A case control study. Journal of dental sciences, 17(2), 780–786. https://doi.org/10.1016/j.jds.2021.10.005
Kumar, A., Rao, A., Nimkar, A., Mahajani, M., Suvvari, R. K., & Bhanot, R. (2021). Evaluating the Need of Continuing the Antiplatelet Drug Therapy in Patients Undergoing Minor Oral Surgical Procedures. Journal of pharmacy & bioallied sciences, 13(Suppl 1), S80–S83. https://doi.org/10.4103/jpbs.JPBS_554_20
Lee, J. K. (2018). Dental management of patients on anti-thrombotic agents. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 44(4), 143-150. https://doi.org/10.5125/jkaoms.2018.44.4.143
Lewandowski, B., Myszka, A., Migut, M., Czenczek-Lewandowska, E., & Brodowski, R. (2021). Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study. BMC oral health, 21(1), 31. https://doi.org/10.1186/s12903-021-01391-9
Li, L., Zhang, W., Yang, Y., Zhao, L., Zhou, X., & Zhang, J. (2019). Dental management of patient with dual antiplatelet therapy: a meta-analysis. Clinical oral investigations, 23(4), 1615–1623. https://doi.org/10.1007/s00784-018-2591-y
Lu, S. Y., Lin, L. H., & Hsue, S. S. (2018). Management of dental extractions in patients on warfarin and antiplatelet therapy. Journal of the Formosan Medical Association = Taiwan yi zhi, 117(11), 979–986. https://doi.org/10.1016/j.jfma.2018.08.019
Mahmood, H., Siddique, I., & McKechnie, A. (2020). Antiplatelet drugs: a review of pharmacology and the perioperative management of patients in oral and maxillofacial surgery. Annals of the Royal College of Surgeons of England, 102(1), 9–13. https://doi.org/10.1308/rcsann.2019.0154
Malik, A. H., & Majeed, S. (2020). Effect of antiplatelet therapy on minor dental procedures. National journal of maxillofacial surgery, 11(1), 64–66. https://doi.org/10.4103/njms.NJMS_30_19
Martínez-Moreno, E., Martínez-López, F., Rodríguez-Lozano, F. J., & Oñate-Sánchez, R. E. (2021). Bleeding Complications in Anticoagulated and/or Antiplatelet-Treated Patients at the Dental Office: A Retrospective Study. International journal of environmental research and public health, 18(4), 1609. https://doi.org/10.3390/ijerph18041609
Mattos, P. C. (2015). Tipos de revisão de literatura. Unesp, 1-9. https://www.fca.unesp.br/Home/Biblioteca/tipos-de-evisao-de-literatura.pdf.
Nagao, Y., Masuda, R., Ando, A., Nonaka, M., Nishimura, A., Goto, K., Maruoka, Y., & Iijima, T. (2018). Whole Blood Platelet Aggregation Test and Prediction of Hemostatic Difficulty After Tooth Extraction in Patients Receiving Antiplatelet Therapy. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 24(1), 151–156. https://doi.org/10.1177/1076029617709086
Ockerman, A., Bornstein, M. M., Leung, Y. Y., Li, S. K. Y., Politis, C., & Jacobs, R. (2020). Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis. International journal of oral and maxillofacial surgery, 49(1), 90–98. https://doi.org/10.1016/j.ijom.2019.06.002
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [free e-book]. Santa Maria/RS. Ed. UAB/NTE/UFSM. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf
Pippi, R., Santoro, M., & Cafolla, A. (2017). The Use of a Chitosan-Derived Hemostatic Agent for Postextraction Bleeding Control in Patients on Antiplatelet Treatment. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 75(6), 1118–1123. https://doi.org/10.1016/j.joms.2017.01.005
Sharma, S., Kale, T. P., Balihallimath, L. J., & Motimath, A. (2017). Evaluating Effectiveness of Axiostat Hemostatic Material in achieving Hemostasis and Healing of Extraction Wounds in Patients on Oral Antiplatelet Drugs. The journal of contemporary dental practice, 18(9), 802–806. https://doi.org/10.5005/jp-journals-10024-2130
Shenoy, A., Panicker, P., Vijayan, A., & George, A. L. (2021). Prospective Comparative Evaluation of Post-extraction Bleeding in Cardiovascular-Compromised Patients with and without Antiplatelet Medications. Journal of maxillofacial and oral surgery, 20(3), 486–495. https://doi.org/10.1007/s12663-019-01315-9
Singh, S., Mandal, S., Chugh, A., Deora, S., Jain, G., Khan, M. A., & Chugh, V. K. (2021). Clinical Post-operative Bleeding During Minor Oral Surgical Procedure and In Vitro Platelet Aggregation in Patients on Aspirin Therapy: Are they Coherent?. Journal of maxillofacial and oral surgery, 20(1), 132–137. https://doi.org/10.1007/s12663-020-01438-4
Sunu, V. S., Roshni, A., Ummar, M., Aslam, S. A., Nair, R. B., & Thomas, T. (2021). A longitudinal study to evaluate the bleeding pattern of patients on low dose aspirin therapy following dental extraction. Journal of family medicine and primary care, 10(3), 1399–1403. https://doi.org/10.4103/jfmpc.jfmpc_312_20
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. The British journal of oral & maxillofacial surgery, 56(9), 854–858. https://doi.org/10.1016/j.bjoms.2018.09.009
Tokarek, T., Homaj, M., Zabojszcz, M., Dolecka-Ślusarczyk, M., Szotek, M., Sabatowski, K., Loster, B., Bartuś, S., & Siudak, Z. (2020). Knowledge on the guideline-recommended use of antiplatelet and anticoagulant therapy during dental extractions: a contemporary survey among Polish dentists. Kardiologia polska, 78(11), 1122–1128. https://doi.org/10.33963/KP.15588
Villanueva, J., Salazar, J., Alarcón, A., Araya, I., Yanine, N., Domancic, S., & Carrasco-Labra, A. (2019). Antiplatelet therapy in patients undergoing oral surgery: A systematic review and meta-analysis. Medicina oral, patologia oral y cirugia bucal, 24(1), e103–e113. https://doi.org/10.4317/medoral.22708
Yanamoto, S., Hasegawa, T., Rokutanda, S., Komori, S., Tachibana, A., Kojima, Y., Koyama, Y., Shibuya, Y., Kurita, H., Komori, T., Umeda, M., & Japanese Study Group of Cooperative Dentistry with Medicine (2017). Multicenter Retrospective Study of the Risk Factors of Hemorrhage After Tooth Extraction in Patients Receiving Antiplatelet Therapy. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 75(7), 1338–1343. https://doi.org/10.1016/j.joms.2017.02.023
Zabojszcz, M., Malinowski, K. P., Janion-Sadowska, A., Lillis, T., Ziakas, A., Sławska, A., Janion, M., & Siudak, Z. (2019). Safety of dental extractions in patients on dual antiplatelet therapy - a meta-analysis. Postepy w kardiologii interwencyjnej = Advances in interventional cardiology, 15(1), 68–73. https://doi.org/10.5114/aic.2019.83773
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