title: Dental postoperative bleeding complications in patients with suspected and documented liver disease.
abstract: OBJECTIVE
  The aims of this study were to determine the frequency of bleeding complications following dental procedures in patients with known or suspected chronic liver disease and whether international normalized ratio (INR) determination could aid in predicting bleeding complications in these patients.
  
  
  METHODS
  We identified 90 patients (mean age: 51 ± 9 years) in this retrospective chart review. Sixty-nine patients had a known history of chronic liver disease and 21 had suspected chronic liver disease. Descriptive statistics were determined. Independent sample t-test and one-way variance test were utilized for continuous variables and chi-square test for dichotomous variables.
  
  
  RESULTS
  The mean INR value for all patients was 1.2 ± 0.3. The INR value was significantly associated with the diagnosis of liver cirrhosis, the diagnoses of Hepatitis B and C together, the presence of ascites alone, and the number of clinical signs and symptoms (i.e. ascites, jaundice and encephalopathy) present. Nine patients with INR values between 1.5 and 2 underwent invasive dental procedures without postoperative bleeding complications.
  
  
  CONCLUSIONS
  There were no episodes of postoperative bleeding in patients. The findings suggest that clinicians should not rely solely on an INR value to predict post-procedure bleeding in patients with liver disease.
authors.affiliation: Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA. denchhl@nus.edu.eg
authors.forename: C H
authors.initials: CH
authors.lastname: Hong
authors.forename: M W
authors.initials: MW
authors.lastname: Scobey
authors.forename: J J
authors.initials: JJ
authors.lastname: Napenas
authors.forename: M T
authors.initials: MT
authors.lastname: Brennan
authors.forename: P B
authors.initials: PB
authors.lastname: Lockhart
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D017742:Dental Care for Chronically Ill; D003777:Dental Prophylaxis / Q000009:adverse effects*; D005260:Female; D006505:Hepatitis / Q000150:complications*; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000009:adverse effects*