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Cuidados peri-operatórios em cirurgia oral de pacientes submetidos a terapêutica anticoagulante : revisão bibliográfica
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| 6.76 MB | Adobe PDF |
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Abstract(s)
O aumento da prevalência de pacientes hipocoagulados na consulta de Medicina Dentária e a necessidade de intervenções cirúrgicas pressionam a necessidade de se estabelecer normas de orientação clínicas peri-operatórias, para uma abordagem terapêutica segura e correta dos mesmos.
Os Novos Anticoagulantes Orais (Dabigatrano, Rivaroxabano e Edoxabano) surgiram como alternativa à Varfarina, apresentando eficácia semelhante e segurança superior,
com menos interações alimentares, medicamentosas e menor risco de hemorragia.
Os Médicos Dentistas devem conhecer os mecanismos de coagulação sanguínea para melhor entenderem o mecanismo de ação dos anticoagulantes orais.
A avaliação do risco hemorrágico é fulcral no planeamento da cirurgia oral de um paciente submetido a terapêutica anticoagulante.
Permanece sobre os profissionais de saúde uma controvérsia acerca da necessidade de suspensão ou manutenção da terapêutica, associada ao risco de tromboembolismo e hemorragia, respetivamente.
A opção de manter ou suspender a terapia anticoagulante depende do risco hemorrágico
individual e do procedimento cirúrgico a realizar. Esta decisão deve ser discutida com o
Médico Assistente, sempre que necessário.
A presente revisão bibliográfica visa esclarecer quais as medidas pré, trans e pósoperatórias a tomar, de forma a diminuir as complicações cirúrgicas associadas a pacientes submetidos a terapêutica anticoagulante oral.
The increase in the prevalence of hipocoagulated patients at the dental appointment and the need of surgical intervention, drive the need of setting clinical peri-operative guidelines, for a safe and correct therapeutic approach. The new oral anticoagulants (Dabigatran, Rivaroxaban and Edoxaban) appeared as an alternative to Warfarin, presenting similar effectiveness and increased security, with less food and drug interactions and lower bleeding scores. Dentists should recognize the mechanisms involved in coagulation, in order to better understand the mechanism of action of oral anticoagulants. The evaluation of the bleeding risk is crucial in the planning of the oral surgery of a patient submitted to anticoagulation therapy. There remains a controversy associated with health professionals, regarding the need of suspending or maintaining the therapeutic approach related to the risk of developing thromboembolisms and hemorrhage, respectively. The option of whether to keep or suspend anticoagulant therapy depends on the individual bleeding risk and the surgical procedure to be made. This decision should be discussed with the assisting doctor, as much as needed. The present literature review aims to clarify which measures should be taken before, during and after surgery, in order to decrease surgical complications associated with patients submitted to oral anticoagulation therapy.
The increase in the prevalence of hipocoagulated patients at the dental appointment and the need of surgical intervention, drive the need of setting clinical peri-operative guidelines, for a safe and correct therapeutic approach. The new oral anticoagulants (Dabigatran, Rivaroxaban and Edoxaban) appeared as an alternative to Warfarin, presenting similar effectiveness and increased security, with less food and drug interactions and lower bleeding scores. Dentists should recognize the mechanisms involved in coagulation, in order to better understand the mechanism of action of oral anticoagulants. The evaluation of the bleeding risk is crucial in the planning of the oral surgery of a patient submitted to anticoagulation therapy. There remains a controversy associated with health professionals, regarding the need of suspending or maintaining the therapeutic approach related to the risk of developing thromboembolisms and hemorrhage, respectively. The option of whether to keep or suspend anticoagulant therapy depends on the individual bleeding risk and the surgical procedure to be made. This decision should be discussed with the assisting doctor, as much as needed. The present literature review aims to clarify which measures should be taken before, during and after surgery, in order to decrease surgical complications associated with patients submitted to oral anticoagulation therapy.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Cirurgia oral Dabigatrano Rivaroxabano Edoxabano