Postoperative bleeding after dental extraction in the liver pretransplant patient

Introduction: During dentoalveolar surgery, liver transplant candidates need special care regarding hemostasis impairment, related to reduced hepatic synthesis of procoagulants factors and thrombocytopenia.

Purpose: The aim of this prospective study was to evaluate the incidence of postoperative bleeding after dental extraction in candidates for liver transplantation.

Patients and methods: A prospective cross-sectional observational study was performed with individuals awaiting liver transplantation and referred for oral health evaluation. All the subjects with dental foci that required extraction were considered to this study. Patients were included in the analysis when the blood exams were according to: platelet count ≥30,000/mm 3 and INR ≤ 3.0. Absorbable hemostatic sponges and cross sutures were used as a standard hemostatic measure. All tooth extractions were performed without administration of blood products (platelet concentrate, fresh frozen plasma).

Results: In 23 patients included in this study, 84 simple extractions were performed in 35 dental surgical procedures. The main preoperative blood tests found were: mean hematocrit of 34.54% (SD ± 5.84, range 21.7–44.4%), platelets ranged from 31,000/mm 3 to 160,000/mm 3 , mean international normalized ratio (INR) was 1.50 (SD ± 0.39; range 0.98–2.59). Postoperative bleeding occurred in only one procedure (2.9%) and local pressure with gauze was effective to achieve hemostasis.

Conclusion: This paper demonstrates the low bleeding risk of tooth extractions in patients with liver cirrhosis, with INR ≤ 2.50 and platelets ≥30,000/mm 3 , without the need of blood transfusion, and in case of bleeding events, the use of local hemostatic measures can be satisfactory.

Conflict of interest: None declared.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Postoperative bleeding after dental extraction in the liver pretransplant patient
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