Saúde bucal em pacientes em terapia anticoagulante e efetividade das terapias hemostáticas para a prevenção do sangramento

Abstract

This study aimed to determine the effectiveness of hemostatic protocols in anticoagulated patients to prevent bleeding in dental procedures and describe the factors associated with quality of life and oral health-related to patients undergoing oral anticoagulant therapy with warfarin. In the first instance, in the systematic review and network meta-analysis, a search of the literature was conducted in different databases where clinical trials were evaluated to determine the effectiveness of hemostatic protocols. Data extraction and assessment of the risk of bias (JBI and Cochrane tools) of the included articles were performed. Assessment of the certainty of the evidence (GRADE) was also performed. As results we find that the N-butyl-2-cyanoacrylate [RR -35.00 (95% CI - 107.12, -5.78)], calcium sulfate (CaSO4) [RR -5.62 (95% CI -11.41, -1.03)], and tranexamic acid (TXA) [RR -3.46 (95% CI -7.63, -0.77)] showed beneficial effects compared to placebo. However, only TXA presented beneficial effects with moderate certainty evidence. N-butyl-2-cyanoacrylate and CaSO4 presented very low certainty evidence. No differences were observed between hemostatic agents in preventing bleeding events. Concluding, the bleeding events in individuals on oral anticoagulation decreased with the use of TXA compared to placebo. N-butyl-2-cyanoacrylate and CaSO4 were also superior to placebo, but the certainty of the evidence was low. For the mean bleeding time, no significant difference in hemostatic agents was observed. On the other hand, a the cross-sectional study was performed, validated questionnaires assessed self-reported periodontal disease, demographic variables, and OHRQoL, using the short version of the Oral Health Impact Profile (OHIP-14) instrument in anticoagulated patients at a Belo Horizonte, Brazil. After calibration (Kappa = 0,95), an examiner evaluated patients’ experience with dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Negative binomial regression models were used to estimate the rate ratios (RR) and the corresponding 95% confidence interval (CI). The OHIP-14 mean was 10.62 (SD = 10.92). A higher OHIP-14 total score (low OHRQoL) was associated with an ethnic group, age, periodontal disease self-report, dental caries, and oral health self-report. Concluding, the burden of oral diseases among individuals undergoing OAT is worrisome. Additionally, demographic and clinical factors have an influence on the perception of anticoagulated patients on OHRQoL.