Manejo odontológico de pacientes que tomen medicamentos anticoagulantes: revisión bibliográfica

Autores/as

DOI:

https://doi.org/10.31790/inspilip.v8i25.581

Palabras clave:

Anticoagulantes, manejo odontológico, enfermedades cardiovasculares, protocolo de atención.

Resumen

Introducción: El manejo odontológico de pacientes que usan anticoagulantes es fundamental para prevenir eventos tromboembólicos con el riesgo de hemorragias. Objetivo: Determinar un protocolo adecuado del manejo odontológico de pacientes que tomen medicamentos anticoagulantes.  Metodología: Estudio de revisión bibliográfica narrativa, con la búsqueda de estudios publicados durante 2017–2024. Se utilizaron palabras clave en PubMed, Scopus y Web of Science; el universo fue de 324 publicaciones y la selección final de 50 artículos. Resultados: El tiempo de protrombina se refleja en los resultados del índice internacional normalizado (INR).  Los rangos seguros de INR para procedimientos odontológicos varían significativamente, siendo complementados por parámetros como: plaquetas, hemoglobina y hematocrito. Los anticoagulantes orales más frecuentes incluyen warfarina, dabigatrán, rivaroxabán y apixabán. Conclusiones: El manejo odontológico de pacientes anticoagulados, basado en una comprensión detallada de los rangos de INR, los parámetros hemáticos clave y las características específicas de los anticoagulantes orales, es esencial para minimizar los riesgos de hemorragia y asegurar tratamientos dentales seguros y efectivos.

Citas

Yamunaqué-Vire J, Merchán-Reye F, Guillén-Guerrero P. Manejo de la extracción dental en pacientes sometidos a terapia anticoagulante: una revisión de la literatura. Revista OACTIVA UC Cuenca [Internet]. 2021;6(2):1-10. Disponible en: https://oactiva.ucacue.edu.ec/index.php/oactiva/article/view/566

Sequeira P, Olivera Garcia AP. Manejo del paciente anticoagulado en una cirugía dental. Salud Militar [Internet]. 6 de diciembre de 2022;41(2):1-11. Disponible en: https://revistasaludmilitar.uy/ojs/index.php/Rsm/article/view/383

Cáceres A, Areyuna L, Figueroa L. Direct Acting Oral Anticoagulants and their Implications in Dental Extraction: A Systematic Review. International Journal of Odontostomatology [Internet]. 2021;15(3):646-52. Disponible en: http://dx.doi.org/10.4067/S0718-381X2021000300646

De Souza Alves Andrade G, De Almeida Góes Silva JV, Alves Lima E, Andrade Ávila G, Soares Macci D, Silva César M, et al. Uso de agentes hemostáticos para el manejo de pacientes anticoagulados. en cirugía oral: una revisión de la literatura. Revista Brasileña de Desarrollo. 2021;7(9):90244-58.

Curto A, Albaladejo A, Alvarado A. Dental management of patients taking novel oral anticoagulants (NOAs): Dabigatran. J Clin Exp Dent [Internet]. 2017;9(2):e289-93. Disponible en: http://www.medicinaoral.com/odo/volumenes/v9i2/jcedv9i2p289.pdf

Costa Tort J, Schiavo-Di Flaviano V, González-Navarro B, Jané-Salas E, Estrugo-Devesa A, López-López J. Update on the management of anticoagulation and antiaggregants. J Clin Exp Dent [Internet]. 2021;13(9):e948-56. Disponible en: https://doi.org/10.4317/jced.58586

Kelly N, Beaton L, Knights J, Stirling D, West M, Young L. The practices and beliefs of dental professionals regarding the management of patients taking anticoagulant and antiplatelet drugs. BDJ Open [Internet]. 2023;9(1):1-8. Disponible en: https://doi.org/10.1038/s41405-022-00127-3

Brien L. Anticoagulant Medications for the Prevention and Treatment of Thromboembolism. AACN Adv Crit Care [Internet]. 2019;30(2):126-38. Disponible en: https://doi.org/10.4037/aacnacc2019867

Pastor Ramos V, Rodríguez Alonso E, Prieto Checa I. Anticoagulantes orales de acción directa y su relación con la práctica clínica odontológica. Medicina General y de Familia [Internet]. 2020;9(02):66-74. Disponible en: http://dx.doi.org/10.24038/mgyf.2020.016

Heestermans M, Poenou G, Hamzeh-Cognasse H, Cognasse F, Bertoletti L. Anticoagulants: A Short History, Their Mechanism of Action, Pharmacology, and Indications. Cells [Internet]. 2022;11(20:3214):1-17. Disponible en: https://doi.org/10.3390/cells11203214

Roberti R, Iannone LF, Palleria C, Curcio A, Rossi M, Sciacqua A, et al. Direct Oral Anticoagulants: From Randomized Clinical Trials to Real-World Clinical Practice. Front Pharmacol [Internet]. 2021;12(684638):1-14. Disponible en: https://doi.org/10.3389/fphar.2021.684638

Zhang C, Wang J, Yang Y, Ma EL, Lin HW, Liu BL, et al. Prescribing Trends of Oral Anticoagulants from 2010 to 2020 in Shanghai, China: A Retrospective Study. Clin Appl Thromb Hemost [Internet]. 2022;28(107602962211325):1-10. Disponible en: https://doi.org/10.1177/10760296221132551

Toma MM, Bungau SG, Tit DM, Moisi MI, Bustea C, Vesa CM, et al. Use of anticoagulant drugs in patients with atrial fibrillation. Does adherence to therapy have a prognostic impact? Biomedicine & Pharmacotherapy [Internet]. 2022;150(113002):1-12. Disponible en: https://doi.org/10.1016/j.biopha.2022.113002

De Andrade NK, Motta RHL, Bergamaschi C de C, Oliveira LB, Guimarães CC, Araújo J de O, et al. Bleeding Risk in Patients Using Oral Anticoagulants Undergoing Surgical Procedures in Dentistry: A Systematic Review and Meta-Analysis. Front Pharmacol [Internet]. 2019;10(866):1-10. Disponible en: https://doi.org/10.3389/fphar.2019.00866

Gupta K, Kumar S, Anand Kukkamalla M, Taneja V, Syed GA, Pullishery F, et al. Dental Management Considerations for Patients with Cardiovascular Disease—A Narrative Review. Rev Cardiovasc Med [Internet]. 2022;23(8:261):1-15. Disponible en: https://doi.org/10.31083/j.rcm2308261

Felix J, Chaban P, Ouanounou A. Dental Management of Patients Undergoing Antithrombotic Therapy. J Can Dent Assoc [Internet]. 2020;69(1):31-6. Disponible en: https://doi.org/10.36290/vnl.2023.004

Best JG, Jesuthasan A, Werring DJ. Cerebral small vessel disease and intracranial bleeding risk: Prognostic and practical significance. International Journal of Stroke [Internet]. 2023;18(1):44-52. Disponible en: https://doi.org/10.1177/17474930221106014

Song J. Consideration of NOACs (novel or non-vitamin K-dependent oral anticoagulants) in dental procedure. J Korean Assoc Oral Maxillofac Surg [Internet]. 2021;47(6):409-10. Disponible en: https://doi.org/10.5125/jkaoms.2021.47.6.409

Tomaszuk-Kazberuk A, Kołtowski Ł, Balsam P, Koziński M, Kapłon-Cieślicka A, Kupczyńska K, et al. Use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation — Messages from the 2018 EHRA. Cardiology Journal. 2018;25(4):423-40.

Squizzato A, Poli D, Barcellona D, Ciampa A, Grandone E, Manott C, et al. Management of DOAC in Patients Undergoing Planned Surgery or Invasive Procedure: Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies (FCSA) Position Paper. Thrombosis and Haemostasis [Internet]. 2022;122(3):329-35. Disponible en: https://doi.org/10.1055/a-1715-5960

Gorla R, Dentali F, Crippa M, Marazzato J, Di Minno MND, Grandi AM, et al. Perioperative Safety and Efficacy of Different Anticoagulation Strategies With Direct Oral Anticoagulants in Pulmonary Vein Isolation: A Meta-Analysis. JACC Clin Electrophysiol [Internet]. 2018;4(6):794-806. Disponible en: https://doi.org/10.1016/j.jacep.2018.04.006

Mahardawi B, Jiaranuchart S, Arunjaroensuk S, Tompkins KA, Somboonsavatdee A, Pimkhaokham A. The effect of different hemostatic agents following dental extraction in patients under oral antithrombotic therapy: a network meta-analysis. Sci Rep [Internet]. 2023;13(12519):1-14. Disponible en: https://doi.org/10.1038/s41598-023-39023-7

Darwish G. The Effect of Direct Oral Anticoagulant Therapy (DOACs) on oral surgical procedures: a systematic review. BMC Oral Health [Internet]. 2023;23(743):1-12. Disponible en: https://doi.org/10.1186/s12903-023-03427-8

Lu SY, Lin LH, Hsue SS. Management of dental extractions in patients on warfarin and antiplatelet therapy. Journal of Formosan Medical Association [Internet]. 2018;1-8. Disponible en: https://doi.org/10.1016/j.jfma.2018.08.019

Tripathi MM, Egawa S, Wirth AG, Tshikudi DM, Van Cott EM, Nadkarni SK. Clinical evaluation of whole blood prothrombin time (PT) and international normalized ratio (INR) using a Laser Speckle Rheology sensor. Sci Rep [Internet]. 2017;7(9169):1-8. Disponible en: https://doi.org/10.1038/s41598-017-08693-5

Eltohami YI. Knowledge, attitude and practices of Dentists regarding management of patients on warfarin therapy. ADOH [Internet]. 2020;12(2). Disponible en: https://dx.doi.org/10.19080/ADOH.2019.11.555834

Fan G, Shen Y, Cai Y, Zhao J hong, Wu Y. Uncontrollable bleeding after tooth extraction from asymptomatic mild hemophilia patients: two case reports. BMC Oral Health [Internet]. 2022;22(69):1-8. Disponible en: https://doi.org/10.1186/s12903-022-02074-9

Minervini G, Franco R, Marrapodi M, Di Blasio M, Cicciù M, Ronsivalle V. The effectiveness of chitosan as a hemostatic in dentistry in patients with antiplatelet/ anticoagulant therapy: systematic review with meta-analysis. BMC Oral Health [Internet]. 2024;24(70):1-13. Disponible en: https://doi.org/10.1186/s12903-023-03568-w

Lam T, Medcalf RL, Cloud GC, Myles PS, Keragala CB. Tranexamic acid for haemostasis and beyond: does dose matter? Thrombosis J [Internet]. 2023;21(94):1-12. Disponible en: https://doi.org/10.1186/s12959-023-00540-0

Zaib A, Shaheryar M, Shakil M, Sarfraz A, Sarfraz Z, Cherrez-Ojeda I. Local Tranexamic Acid for Preventing Hemorrhage in Anticoagulated Patients Undergoing Dental and Minor Oral Procedures: A Systematic Review and Meta-Analysis. Healthcare (Basel) [Internet]. 2022;10(12:2523):1-12. Disponible en: https://doi.org/10.3390/healthcare10122523

Zhong Y, Hu H, Min N, Wei Y, Li X, Li X. Application and outlook of topical hemostatic materials: a narrative review. Ann Transl Med [Internet]. 2021;9(7):577-577. Disponible en: http://dx.doi.org/10.21037/at

Roshkovan L, Singhal S, Katz SI, Galperin-Aizenberg M. Multimodality imaging of Surgicel®, an important mimic of post-operative complication in the thorax. BJR Open [Internet]. 2021;3(1):1-6. Disponible en: https://doi.org/10.1259/bjro.20210031

Khoshmohabat H, Paydar S, Makarem A, Karami MY, Dastgheib N, Zahraei SAH, et al. A review of the application of cellulose hemostatic agent on trauma injuries. Open Access Emerg Med [Internet]. 2019;11:171-7. Disponible en: https://doi.org/10.2147/OAEM.S205006

AbiMansour JP, Garimella V, Petersen BT, Law RJ, Storm AC, Martin JA, et al. Risk of post-sphincterotomy bleeding in patients with thrombocytopenia. Clin Med Insights Gastroenterol [Internet]. 2023;16(26317745231200971):1-10. Disponible en: https://doi.org/10.1177/26317745231200971

Rahman MA, Shanjana Y, Tushar MI, Mahmud T, Rahman GMS, Milan ZH, et al. Hematological abnormalities and comorbidities are associated with COVID-19 severity among hospitalized patients: Experience from Bangladesh. PLoS One [Internet]. 2021;16(7:e0255379):1-16. Disponible en: https://doi.org/10.1371/journal.pone.0255379

Carvalho Y. Anticoagulants and their effects on the hematological and biochemical parameters of yellow-spotted amazon river turtle. Cienc Rural [Internet]. 2022;52(12). Disponible en: https://doi.org/10.1590/0103-8478cr20210489

Gunasekaran K, Rajasurya V, Devasahayam J, Singh Rahi M, Chandran A, Elango K, et al. A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants. J Clin Med [Internet]. 15 de septiembre de 2020;9(9:2984):1-18. Disponible en: https://doi.org/10.3390/jcm9092984

Wang M, Zeraatkar D, Obeda M, Lee M, Garcia C, Nguyen L, et al. Drug-drug interactions with warfarin: A systematic review and meta-analysis. Br J Clin Pharmacol [Internet]. 2021;87(11):4051-100. Disponible en: https://doi.org/10.1111/bcp.14833

Dhakal P, Rayamajhi S, Verma V, Gundabolu K, Bhatt VR. Reversal of Anticoagulation and Management of Bleeding in Patients on Anticoagulants. Clin Appl Thromb Hemost [Internet]. 2017;23(5):410-5. Disponible en: https://doi.org/10.1177/1076029616675970

Sennesael AL, Larock AS, Douxfils J, Elens L, Stillemans G, Wiesen M, et al. Rivaroxaban plasma levels in patients admitted for bleeding events: insights from a prospective study. Thrombosis J [Internet]. 2018;16(28):1-8. Disponible en: https://doi.org/10.1186/s12959-018-0183-3

Byon W, Garonzik S, Boyd RA, Frost CE. Apixaban: A Clinical Pharmacokinetic and Pharmacodynamic Review. Clin Pharmacokinet [Internet]. 2019;58(10):1265-79. Disponible en: https://doi.org/10.1007/s40262-019-00775-z

Shnayder NA, Petrova MM, Shesternya PA, Savinova AV, Bochanova EN, Zimnitskaya OV, et al. Using Pharmacogenetics of Direct Oral Anticoagulants to Predict Changes in Their Pharmacokinetics and the Risk of Adverse Drug Reactions. Biomedicines [Internet]. 2021;9(5:451):1-19. Disponible en: https://doi.org/10.3390/biomedicines9050451

Łętek A, Zandecki Ł, Janion-Sadowska A, Polewczyk A. Interruption of anticoagulation in patients undergoing elective surgical procedures. sm [Internet]. 2020;36(1):51-9. Disponible en: https://doi.org/10.5114/ms.2020.94089

Chen C, Saxena M, Von Heymann C, Vanassche T, Jin J, Lersch R, et al. Edoxaban use in the context of dental procedures: analysis from the EMIT-AF/VTE database. BDJ Open [Internet]. 2023;9(38):1-5. Disponible en: https://doi.org/10.1038/s41405-023-00164-6

Buchbender M, Rößler F, Kesting MR, Frohwitter G, Adler W, Rau A. Management of anticoagulated patients in dentoalveolar surgery: a retrospective study comparing bridging with heparin versus unpaused vitamin K antagonist medication. BMC Oral Health [Internet]. 2021;21(96):1-8. Disponible en: https://doi.org/10.1186/s12903-021-01464-9

Urbonas G, Valius L, Šakalytė G, Petniūnas K, Petniūnienė I. The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting. Medicina [Internet]. 2019;55(15):1-11. Disponible en: https://doi.org/10.3390/medicina55010015

Berkowitz JL, Taylor MA, Lima FV, Hyder O. Managing Anticoagulation and Dual Antiplatelet Therapy in Patients with Active Bleed or Upcoming Procedure: A Scoping Review. Journal of Brown Hospital Medicine [Internet]. 2023;2(3):1-12. Disponible en: https://doi.org/10.56305/001c.81037

Lee H, Kim HJ, Chang HW, Kim DJ, Mo J, Kim JE. Development of a system to support warfarin dose decisions using deep neural networks. Sci Rep [Internet]. 2021;11(14745):1-10. Disponible en: https://doi.org/10.1038/s41598-021-94305-2

Enomoto A, Mano Y, Kawano Y, Nishikawa T, Aoyama T, Sasaki Y, et al. Comparison of the Safety and Effectiveness of Four Direct Oral Anticoagulants in Japanese Patients with Nonvalvular Atrial Fibrillation Using Real-World Data. Biological & Pharmaceutical Bulletin [Internet]. 2021;44(9):1294-302. Disponible en: https://doi.org/10.1248/bpb.b21-00230

Helin T, Joutsi-Korhonen L, Lassila R. Clinical use and laboratory testing of oral anticoagulation therapy: experience from Finland. Ann Blood [Internet]. 2019;4:17-17. Disponible en: http://dx.doi.org/10.21037/aob.2019.07.01

Publicado

05/05/2024

Cómo citar

Guayas Carrión, P., & Matute Merchán, S. (2024). Manejo odontológico de pacientes que tomen medicamentos anticoagulantes: revisión bibliográfica. INSPILIP, 8(25), 53–64. https://doi.org/10.31790/inspilip.v8i25.581