title: [Retrospective study on bleeding and thromboembolic complications related to tooth extraction, in 93 patients usually treated by antithrombotic therapy].
abstract: BACKGROUND
  Tooth extraction for patients treated by AVK and/or platelet aggregation inhibitor is performed according to local habits rather than to a consensus. We had for objective to assess hemorrhagic and thromboembolic risks for patients for whom treatment with AVK and/or platelet aggregation inhibitor was modified before tooth extraction.
  
  
  METHODS
  Ninety-three patient files were examined retrospectively. The following data was collected: epidemiological data, ASA score, nature and changes of antithrombotic therapy, preoperative INR, number teeth extracted, postoperative complications (bleeding and thromboembolic events).
  
  
  RESULTS
  Thirty-seven patients were treated with oral anticoagulants, 41 by a platelet aggregation inhibitor, 10 by double platelet aggregation inhibitor therapy, and 5 by an AVK-platelet aggregation inhibitor combination. At D0, the mean INR was decreased to 1.4, 4 patients with high thromboembolic risk had received heparin relay treatment; the treatment was stopped for 9 of the 56 patients on monotherapy with antiplatelet therapy, 4 were switched from clopidogrel to lysine acetylate; clopidogrel was stopped for 7 patients under combination therapy. Seven hundred and twenty-six avulsions (mean 8.1 per patient) were performed, 41 patients presented with mild/moderate bleeding, easily resolved. A patient presented with delayed hemorrhage at D6 (AVK overdose). No thromboembolic complication was reported.
  
  
  CONCLUSIONS
  The modification of antithrombotic treatment, as for surgery at high risk of bleeding, seems to limit the risk of bleeding without increasing thromboembolic risk.
authors.affiliation: NHE, service d'odontologie, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Sui
authors.affiliation: NHE, service d'odontologie, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; UMR Inserm/UdA, U1107, neuro-dol, trigeminal pain and migraine, faculté de chirurgie dentaire, BP 10448, 63000 Clermont-Ferrand, France; Faculté de chirurgie dentaire, Clermont université, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France.
authors.forename: L
authors.initials: L
authors.lastname: Devoize
authors.affiliation: NHE, département d'anesthésie-réanimation, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors.forename: S
authors.initials: S
authors.lastname: Gonnu-Levallois
authors.affiliation: GM, service de biostatistique, délégation recherche clinique et innovation, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Mulliez
authors.affiliation: NHE, service d'odontologie, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; UMR Inserm/UdA, U1107, neuro-dol, trigeminal pain and migraine, faculté de chirurgie dentaire, BP 10448, 63000 Clermont-Ferrand, France; Faculté de chirurgie dentaire, Clermont université, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France.
authors.forename: M
authors.initials: M
authors.lastname: Baudet-Pommel
authors.affiliation: NHE, service de chirurgie maxillo-faciale, stomatologie et chirurgie plastique de la face, NHE, CHU de Clermont-Ferrand, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France; UMR Inserm/UdA, U1107, neuro-dol, trigeminal pain and migraine, faculté de chirurgie dentaire, BP 10448, 63000 Clermont-Ferrand, France; Faculté de médecine, Clermont université, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France.
authors.forename: I
authors.initials: I
authors.lastname: Barthélémy
authors.affiliation: NHE, service de chirurgie maxillo-faciale, stomatologie et chirurgie plastique de la face, NHE, CHU de Clermont-Ferrand, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France; UMR Inserm/UdA, U1107, neuro-dol, trigeminal pain and migraine, faculté de chirurgie dentaire, BP 10448, 63000 Clermont-Ferrand, France. Electronic address: nphamdang@chu-clermontferrand.fr.
authors.forename: N Pham
authors.initials: NP
authors.lastname: Dang
mesh_terms: D015110:4-Hydroxycoumarins / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007192:Indenes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control; D014081:Tooth Extraction / Q000009:adverse effects* / Q000706:statistics & numerical data; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000627:therapeutic use
chemical_list: D015110:4-Hydroxycoumarins; D005343:Fibrinolytic Agents; D007192:Indenes; C011664:antivitamins K; D014812:Vitamin K
keywords: Antiagrégants plaquettaires; Anticoagulant drugs; Anticoagulants; Avulsion dentaire; Hemorrhage; Hémorragie; Platelet aggregation inhibitor; Risque thromboembolique; Thromboembolic risk; Tooth extraction