Universität zu Köln

Zirk, Matthias, Fienitz, Tim, Edel, Robin, Kreppel, Matthias, Dreiseidler, Timo and Rothamel, Daniel (2016). Prevention of post-operative bleeding in hemostatic compromised patients using native porcine collagen fleeces-retrospective study of a consecutive case series. Oral Maxillofac. Surg.-Heidelb., 20 (3). S. 249 - 255. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1865-1569

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Abstract

Various anticoagulant therapy regimes bear the risk of postsurgical bleeding events after dental extractions. Local hemostyptic measures, e.g., collagen fleeces, are applied by surgeons to prevent such bleedings. No standard protocol in prevention of bleeding events has met general acceptance among surgeons yet. The purpose of this retrospective study was to determine if post-operative bleeding can be prevented by suturing native collagen fleeces into extraction wounds immediately after teeth removal, regardless what anticoagulant regime is performed. A total of 741 extraction units were removed from 200 consecutive in-ward patients with or without alternation of different anticoagulant therapy regimes. Anti-vitamin K agents were the most prescribed drugs (n = 104, 52 %), followed by Acetylsalicylate (ASS) (n = 78, 39 %). Nineteen (9.5 %) patients received a dual anti-platelet therapy. Out of 104 patients receiving an anti-vitamin K agent (phenprocoumon), 84 patients were bridged, 20 patients continued to their anticoagulant therapy without alterations. Following careful tooth extraction, extraction sockets were filled using a native type I and III porcine collagen sponge (Collacone, Botiss Biomaterials, Berlin), supported by single and mattress sutures for local hemostasis. Post-operative bleeding events were rated according to their clinical relevance. In the post-operative phase, 8 out of 200 consecutively treated patients experienced a post-operative bleeding event. All of them had been designated for a long-term anti-vitamin K therapy (p <= 0.05), and extractions were performed under a heparin bridging regime (n = 6) or an uninterrupted anti-vitamin K agent therapy (n = 2). No bleeding events occurred in patients with ASS 100 therapy or low-dose LMWH therapy (p <= 0.05), or in patients with dual anti-platelet therapy (0 out of 24). None of the bleeding events put patients' health at risk or required systemic intervention. Sufficiently performed local hemostyptic measures, like the application of collagen fleeces in combination with atraumatic surgery, bears a great potential for preventing heavy bleeding events in hemostatic compromised patients, regardless of their anticoagulant therapy.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Zirk, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Fienitz, Tim UNSPECIFIED UNSPECIFIED UNSPECIFIED Edel, Robin UNSPECIFIED UNSPECIFIED UNSPECIFIED Kreppel, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Dreiseidler, Timo UNSPECIFIED UNSPECIFIED UNSPECIFIED Rothamel, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-265945
DOI:	10.1007/s10006-016-0560-7
Journal or Publication Title:	Oral Maxillofac. Surg.-Heidelb.
Volume:	20
Number:	3
Page Range:	S. 249 - 255
Date:	2016
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1865-1569
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DENTAL MANAGEMENT CONSIDERATIONS; DUAL ANTIPLATELET THERAPY; ORAL-SURGERY; ACQUIRED COAGULOPATHY; ASPIRIN; ANTICOAGULATION; COMPLICATIONS; METAANALYSIS; EXTRACTIONS; CLOPIDOGREL Multiple languages Dentistry, Oral Surgery & Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26594