Oral surgery in liver transplant candidates : a retrospective study on delayed bleeding and other complications

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http://hdl.handle.net/10138/223984

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Helenius-Hietala , J , Åberg , F , Meurman , J H , Nordin , A & Isoniemi , H 2016 , ' Oral surgery in liver transplant candidates : a retrospective study on delayed bleeding and other complications ' , Oral surgery, oral medicine, oral pathology and oral radiology , vol. 121 , no. 5 , pp. 490-495 . https://doi.org/10.1016/j.oooo.2016.01.025

Title: Oral surgery in liver transplant candidates : a retrospective study on delayed bleeding and other complications
Author: Helenius-Hietala, Jaana; Åberg, Fredrik; Meurman, Jukka H.; Nordin, Arno; Isoniemi, Helena
Other contributor: University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, IV kirurgian klinikka
University of Helsinki, Clinicum





Date: 2016-05
Language: eng
Number of pages: 6
Belongs to series: Oral surgery, oral medicine, oral pathology and oral radiology
ISSN: 2212-4403
DOI: https://doi.org/10.1016/j.oooo.2016.01.025
URI: http://hdl.handle.net/10138/223984
Abstract: Objective. Untreated dental infections pose a threat for immunocompromised liver transplant (LT) recipients. Therefore, pretransplant dental evaluations are recommended. However, risk of bleeding should be considered among patients with end-stage liver disease, and prophylactic blood transfusions may be used to prevent bleeding. We performed a retrospective study of the incidence of and risk factors for oral surgery-related bleeding in candidates for LT and hypothesized that complications may occur despite preoperative and perioperative hemostatic actions. Study Design. One hundred thirty-four patients who had tooth extractions performed by oral and maxillofacial surgeons before LT were studied. The primary endpoint was bleeding between 24 hours and 2 weeks after extraction. Bleeding risk was analyzed by preoperative platelet (PLT) count and international normalized ratio (INR). Invasiveness of procedures, severity of liver disease, PLT, INR, prophylactic transfusions of PLT, fresh frozen plasma, and tranexamic acid (TA) were included in univariate and multivariate logistic regression analyses to further assess risk. Results. Twelve patients exhibited minor bleeding; four despite PLT > 100 x 10(9)/L and INR <1.5. Increased bleeding associated with INR and prophylactic transfusions by univariate analysis; by multivariate analyses, prophylactic TA (odds ratio [OR] = 8.0; 95% confidence interval [CI] 1.7-37.0), and PLT (OR = 8.3; 95% CI 1.1-62.7) remained significant. Conclusions. Most extractions were safe, but prophylactic transfusions did not ensure adequate hemostasis. Local hemostatic measures and close follow-up are warranted.
Subject: CIRRHOTIC-PATIENTS
DISEASE
COAGULATION
TRANSFUSION
PATIENT
COAGULOPATHY
HEMOSTASIS
MANAGEMENT
SUPPORT
313 Dentistry
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