Loading...
Publication
Protocolos de gestão de pacientes anticoagulados submetidos a cirurgia oral
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 660.61 KB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Pacientes em terapia anticoagulante são cada vez mais frequentes em consultas de medicina dentária. Esta é administrada em pessoas com maior risco tromboembólico, o que resulta num maior risco hemorrágico em caso de necessidade de intervenção dentária cirúrgica.
A existência de diferentes tipos de anticoagulantes tais como os antagonistas da vitamina K, anticoagulantes orais diretos e heparinas de baixo peso molecular faz com que estes atuem no organismo por via de diferentes mecanismos e perfis cinéticos, implicando também a aplicação de diferentes abordagens de gestão.
Metodologicamente, procede-se a uma revisão crítica da literatura recente e de recomendações clínicas que se organizam em torno de uma decisão individualizada, sustentada por estratificação dual do risco (doente/procedimento) e por protocolos pré-, intra e pós-operatórios. São destacadas condutas específicas por classe farmacológica como a suspensão controlada e a utilização de antídotos, a importância da comunicação com o médico assistente e da reconciliação terapêutica em cenários de comorbilidade ou polimedicação, bem como o papel da técnica atraumática, a aplicação de novos hemostáticos locais e das instruções pós-operatórias.
A aplicação sistemática de protocolos estruturados, aliada a formação contínua e auditoria, promove cuidados consistentes e centrados no doente, minimizando complicações hemorrágicas sem comprometer a segurança trombótica, e aponta linhas de investigação futura para padronização de desfechos e clarificação do uso de adjuvantes hemostáticos.
Patients on anticoagulant therapy are increasingly frequent in dental consultations. This therapeutic is administered to people with a higher thromboembolic risk, which results in a higher hemorrhagic risk in case of need for surgical dental intervention. The existence of different types of anticoagulants, such as vitamin K antagonists, direct oral anticoagulants and low molecular weight heparins, means that they act in the body through different mechanisms and kinetic profiles, also implying the application of different management approaches. Methodologically, a critical review of recent literature and clinical recommendations is conducted, organized around individualized decision-making, supported by dual risk stratification (patient/procedure) and pre-, intra-, and postoperative protocols. Specific approaches by pharmacological class are highlighted, such as controlled discontinuation and the use of antidotes, the importance of communication with the attending physician and therapeutic reconciliation in scenarios of comorbidity or polypharmacy, as well as the role of the atraumatic technique, the application of new local hemostatic agents, and postoperative instructions. The systematic application of structured protocols, combined with continuous training and auditing, promotes consistent and patient-centered care, minimizing hemorrhagic complications without compromising thrombotic safety, and points to future lines of research for standardization of outcomes and clarification of the use of hemostatic adjuvants.
Patients on anticoagulant therapy are increasingly frequent in dental consultations. This therapeutic is administered to people with a higher thromboembolic risk, which results in a higher hemorrhagic risk in case of need for surgical dental intervention. The existence of different types of anticoagulants, such as vitamin K antagonists, direct oral anticoagulants and low molecular weight heparins, means that they act in the body through different mechanisms and kinetic profiles, also implying the application of different management approaches. Methodologically, a critical review of recent literature and clinical recommendations is conducted, organized around individualized decision-making, supported by dual risk stratification (patient/procedure) and pre-, intra-, and postoperative protocols. Specific approaches by pharmacological class are highlighted, such as controlled discontinuation and the use of antidotes, the importance of communication with the attending physician and therapeutic reconciliation in scenarios of comorbidity or polypharmacy, as well as the role of the atraumatic technique, the application of new local hemostatic agents, and postoperative instructions. The systematic application of structured protocols, combined with continuous training and auditing, promotes consistent and patient-centered care, minimizing hemorrhagic complications without compromising thrombotic safety, and points to future lines of research for standardization of outcomes and clarification of the use of hemostatic adjuvants.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Anticoagulantes Medicina dentária Cirurgia oral Novos anticoagulantes orais