Oral Surgical Treatment of Patients With Chronic Liver Disease: Assessments of Bleeding and Its Relationship With Thrombocytopenia and Blood Coagulation Parameters.
OBJECTIVE
Cirrhotic patients awaiting liver transplantation require eradication of infectious oral foci to prevent septic episodes after transplantation; however, cirrhosis can hinder hemostasis and can result in severe bleeding. The present study assessed the bleeding risk factors connected with the clinical history of these patients and the characteristics of the extractions.


METHODS
We retrospectively analyzed 1183 extractions in 318 patients, including 47 with severe end-stage liver disease who were outside of our intention-to-treat bracket (ie, platelet count [PLT] >40 × 103/μL and international normalized ratio [INR] <2.5). Follow-up examinations included inspection of the oral cavity on the first, third, and seventh days, with reparatory surgery in the case of severe bleeding. Continuous variables were compared using the Mann-Whitney U and Kruskal-Wallis tests, and categorical variables were compared using Fisher's exact test. Binary logistic regression analysis was also performed.


RESULTS
Within the intention-to-treat bracket, 1 of the 271 patients (0.4%) required surgical repair. The bleeding rate for an INR of 2.5 or more was significantly greater than that for a PLT of 40 × 103/μL or less (4 of 10 [40%] versus 2 of 34 [6%]; P = .02]. All 3 patients with both an INR of 2.5 or more and a PLT of 40 × 103/μL or less exhibited severe bleeding. No significant association between the occurrence of bleeding with either liver disease etiology or the number of molars extracted was found. No patient required hospitalization.


CONCLUSIONS
Patients with a PLT greater than 40 × 103/μL and an INR of less than 2.5 can be considered relatively low-risk patients. However, an INR of 2.5 or more and, to a minor degree, a PLT of 40 × 103/μL or less represent significant risk factors.
Consultant, Oral Surgery Section, Dental School, University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Torino, Italy. Electronic address: c_nadia77@libero.it.
Nadia
N
Cocero
Consultant, Oral Surgery Section, Dental School, University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Torino, Italy.
Marta
M
Bezzi
Resident, Gastrohepatology, Molinette Hospital, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
Silvia
S
Martini
Department Head, Department of Surgical Sciences, Dental School, University of Torino, Torino, Italy.
Stefano
S
Carossa
D000328:Adult; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D058625:End Stage Liver Disease / Q000150:complications; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017713:Platelet Transfusion; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D014081:Tooth Extraction / Q000009:adverse effects / Q000379:methods