title: Haemostatic management for oral surgery in patients supported with left ventricular assist device--a preliminary retrospective study.
abstract: We investigated haemostatic management, frequency of postoperative bleeding, and prognosis of patients who had left ventricular assist devices, and who were having oral surgical procedures between April 2002 and March 2014, to identify risk factors for bleeding and find out which were the best methods of haemostasis. Medical records were examined retrospectively and we recorded details of the patients, and frequency of bleeding together with factors associated with it. Twenty-nine patients had 39 oral operations, and there were 17 bleeds (44%). The first procedure for each patient was used for statistical calculations. Duration of bleeding tended to be longer for patients with implantable devices (median (interquartile range, IQR) 12.0 (3-18) days) than for those with extracorporeal devices (median (IQR) 3.0 (1-4) days; p=0.079). There was a significantly greater difference in prothrombin time-international normalised ratio (PT-INR) before and after operation in patients who bled, whose median (range) was 0.85 (0.2-1.81), than in those who did not (median (IQR) 0.16 (-0.09-0.31) (p=0.015). There were moderate correlations with postoperative bleeding were seen for the difference between preoperative and postoperative PT-INR (r=0.479, p=0.012) and PT-INR value when bleeding (r=0.407, p=0.035). In conclusion, postoperative bleeding occurred after oral operations in 17/29 patients with left ventricular assist devices by a median (IQR) of 0.85 (0.2-1.81) of the preoperative value.
authors.affiliation: Department of Anesthesiology, Graduate School of Dentistry, Kanagawa Dental University; Department of Dentistry, National Cerebral and Cardiovascular Center; Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University. Electronic address: morimoto@kdu.ac.jp.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Morimoto
authors.affiliation: Department of Organ Transplantation, National Cerebral and Cardiovascular Center.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
authors.affiliation: Department of Anesthesiology, Graduate School of Dentistry, Kanagawa Dental University.
authors.forename: Chizuko
authors.initials: C
authors.lastname: Yokoe
authors.affiliation: Department of Dentistry, National Cerebral and Cardiovascular Center; Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University.
authors.forename: Chiho
authors.initials: C
authors.lastname: Kudo
authors.affiliation: Department of Dentistry, National Cerebral and Cardiovascular Center; Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hanamoto
authors.affiliation: Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Niwa
mesh_terms: D006353:Heart-Assist Devices / Q000009:adverse effects; D006490:Hemostatics; D006801:Humans; D012189:Retrospective Studies; D013515:Surgery, Oral; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics
keywords: Heart transplantation; Left ventricular assist device (LVAD); Postoperative haemorrhage; Prothrombin time-international normalised ratio (PT-INR); Surgical dental treatment