Dental extraction in the thrombocytopenic patient is safe and complications are easily managed.
OBJECTIVE
To characterize bleeding risk and management of bleeding in thrombocytopenic patients undergoing dental extraction.


METHODS
This retrospective cohort study included 68 patients with hematologic disease and concomitant thrombocytopenia undergoing dental extractions. The inclusion criterion was a platelet count of 100,000/μL or less at the time of consultation or extraction. Patients using anticoagulation therapy were excluded from the study. Predictors measured were age, gender, platelet count, platelet transfusion before or during surgery, local hemostatic measurements at the time of surgery (absorbable hemostat or antifibrinolytic rinse), number of teeth extracted, diagnosis, and extraction type. The primary outcome was postoperative bleeding requiring intervention. A secondary outcome was surgical site infection. Descriptive and bivariate statistics were computed and the P value was set at .05. No logistic regression was used based on the distribution of outcomes.


RESULTS
Sixty-eight patients underwent extraction of 200 teeth. Five (7.4%) had postoperative bleeding that was always controlled with routine intervention. Mean platelet count was 44,647/μL. Bleeding was more frequent with lower platelet levels (P = .048). Thirty-two patients received platelet transfusion and 26 received local measures. Platelet transfusion and local hemostatic measures had no effect on bleeding outcomes.


CONCLUSIONS
Surgical and routine extractions are safe procedures in patients with thrombocytopenia, and postoperative bleeding is typically well handled with simple local measures. The benefits of pre- or intraoperative platelet transfusion are unclear in this population. Likewise, the benefit of prophylactic local hemostatic measures is unclear and should be based on the surgeon's discretion and experience.
Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: jonathanfillmore@gmail.com.
W Jonathan
WJ
Fillmore
Bryce D
BD
Leavitt
Kevin
K
Arce
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D002483:Cellulose, Oxidized / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000150:complications; D006488:Hemostasis, Surgical / Q000379:methods; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000517:prevention & control*; D061214:Patient Safety; D010976:Platelet Count; D017713:Platelet Transfusion; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control; D013921:Thrombocytopenia / Q000150:complications*; D014081:Tooth Extraction / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D000933:Antifibrinolytic Agents; D002483:Cellulose, Oxidized; D006490:Hemostatics; C013695:Surgicel