title: Postoperative bleeding after dental extraction in liver pretransplant patients.
abstract: OBJECTIVE
  The aim of this prospective observational study was to evaluate the incidence of postoperative bleeding after dental extraction in candidates for liver transplantation and the efficacy of the association of tranexamic acid and absorbable hemostatic sponges.
  
  
  METHODS
  All individuals referred for oral health evaluation requiring extraction were considered in this study. Patients were included in the analysis when the blood examinations showed a platelet count of 30,000/mm(3) or greater and an international normalized ratio (INR) of 3.0 or less. In group 1 local pressure was applied by use of gauze soaked with tranexamic acid, and in group 2 gauze without tranexamic acid was used. Absorbable hemostatic sponges and cross sutures were used as a standard hemostatic measure.
  
  
  RESULTS
  In the 23 patients included in this study, 84 simple extractions were performed during 35 dental surgical procedures. The main preoperative blood tests found the following: a mean hematocrit level of 34.54% (SD, 5.84%; range, 21.7%-44.4%), platelet counts from 31,000/mm(3) to 160,000/mm(3), and a mean INR of 1.50 (SD, 0.39; range, 0.98-2.59). Postoperative bleeding occurred during only 1 procedure (2.9%), and local pressure with gauze was effective for achieving hemostasis. No statistically significant difference in the time to hemostasis was found between the 2 groups.
  
  
  CONCLUSIONS
  This study found a low risk of bleeding for tooth extractions in patients with liver cirrhosis, INRs of 2.50 or less, and platelet counts of 30,000/mm(3) or greater. Blood transfusions were not needed, and in the case of postoperative bleeding, the use of local hemostatic measures was satisfactory.
authors.affiliation: School of Dentistry, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: João Paulo Veloso
authors.initials: JP
authors.lastname: Perdigão
authors.forename: Paulo César
authors.initials: PC
authors.lastname: de Almeida
authors.forename: Tarciso Daniel Santos
authors.initials: TD
authors.lastname: Rocha
authors.forename: Mário Rogério Lima
authors.initials: MR
authors.lastname: Mota
authors.forename: Eduardo Costa Studart
authors.initials: EC
authors.lastname: Soares
authors.forename: Ana Paula Negreiros Nunes
authors.initials: AP
authors.lastname: Alves
authors.forename: Fabrício Bitu
authors.initials: FB
authors.lastname: Sousa
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D017742:Dental Care for Chronically Ill; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care; D011312:Pressure; D011446:Prospective Studies; D014081:Tooth Extraction / Q000009:adverse effects*; D014148:Tranexamic Acid / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid