Oral Anticoagulant Therapy Clinical Trial
Official title:
Efficacy of Local Hemostatic Management in Implant Surgery in Anticoagulated Patients on Warfarin: a Randomized Clinical Study
NCT number | NCT04846114 |
Other study ID # | VRID 1500 |
Secondary ID | |
Status | Completed |
Phase | N/A |
First received | |
Last updated | |
Start date | March 2016 |
Est. completion date | June 2019 |
Verified date | October 2022 |
Source | Universidad del Salvador, Argentina |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study evaluated the outcomes in the post-operative recovery following dental implant surgery in patients who continued on oral anticoagulated therapy (OAT) with warfarin. The primary outcome of this study was to evaluate bleeding within the first 5 days post-surgery and presence of intraoral/extraoral hematomas in skin and mucosa oral.
Status | Completed |
Enrollment | 71 |
Est. completion date | June 2019 |
Est. primary completion date | December 2018 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 21 Years to 75 Years |
Eligibility | Inclusion Criteria: Subjects: - Systemically healthy. - Healthy periodontal tissues or well-controlled periodontal health. - In need of a maximum of two dental implants per hemiarcade, - Showing =8mm bone height and =6 horizontal bone width. - Needing a maximum of two surgical procedures. - Who had written consent from the referring service to undergo the surgical procedure. Exclusion Criteria: Subjects: - Requiring implant placement immediately after extraction. - Systemic disease contraindicating implant surgery. - Mental disability preventing them from complying with the protocol. - Hematological, metabolic, autoimmune or bone diseases. - Hepatic alterations or receiving medication affecting liver function. - Receiving corticoid therapy, chemotherapy, or anticoagulant therapy within 10 days prior to the surgery. - Taking antibiotics that interact with oral anticoagulants. - Requiring vertical or periosteal incisions. - Requiring bone regeneration strategy. When treatment involved placing an implant in more than one hemiarcade, the corresponding surgeries were scheduled 30 days apart. |
Country | Name | City | State |
---|---|---|---|
Argentina | Masters in Dental Implantology (MIO) program at the University of Salvador (USAL)-Argentine Dental Association | Buenos Aires |
Lead Sponsor | Collaborator |
---|---|
Jorge Ernesto Aguilar |
Argentina,
Akopov SE, Suzuki S, Fredieu A, Kidwell CS, Saver JL, Cohen SN. Withdrawal of warfarin prior to a surgical procedure: time to follow the guidelines? Cerebrovasc Dis. 2005;19(5):337-42. Epub 2005 Apr 8. — View Citation
Ascani A, Iorio A, Agnelli G. Withdrawal of warfarin after deep vein thrombosis: effects of a low fixed dose on rebound thrombin generation. Blood Coagul Fibrinolysis. 1999 Jul;10(5):291-5. — View Citation
Bacci C, Berengo M, Favero L, Zanon E. Safety of dental implant surgery in patients undergoing anticoagulation therapy: a prospective case-control study. Clin Oral Implants Res. 2011 Feb;22(2):151-6. doi: 10.1111/j.1600-0501.2010.01963.x. Epub 2010 Oct 13 — View Citation
Bajkin BV, Urosevic IM, Stankov KM, Petrovic BB, Bajkin IA. Dental extractions and risk of bleeding in patients taking single and dual antiplatelet treatment. Br J Oral Maxillofac Surg. 2015 Jan;53(1):39-43. doi: 10.1016/j.bjoms.2014.09.009. Epub 2014 Oct — View Citation
Broekema FI, van Minnen B, Jansma J, Bos RR. Risk of bleeding after dentoalveolar surgery in patients taking anticoagulants. Br J Oral Maxillofac Surg. 2014 Mar;52(3):e15-9. doi: 10.1016/j.bjoms.2014.01.006. Epub 2014 Jan 30. — View Citation
Cai J, Ribkoff J, Olson S, Raghunathan V, Al-Samkari H, DeLoughery TG, Shatzel JJ. The many roles of tranexamic acid: An overview of the clinical indications for TXA in medical and surgical patients. Eur J Haematol. 2020 Feb;104(2):79-87. doi: 10.1111/ejh — View Citation
Caliskan M, Tükel HC, Benlidayi ME, Deniz A. Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants? Med Oral Patol Oral Cir Bucal. 2017 Nov 1;22(6):e767-e773. doi: 10.4317/medoral.21942. — View Citation
Callanan V, Curran AJ, Smyth DA, Gormley PK. The influence of bismuth subgallate and adrenaline paste upon operating time and operative blood loss in tonsillectomy. J Laryngol Otol. 1995 Mar;109(3):206-8. — View Citation
Cankaya D, Dasar U, Satilmis AB, Basaran SH, Akkaya M, Bozkurt M. The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty. J Orthop Surg (Hong Ko — View Citation
Clemm R, Neukam FW, Rusche B, Bauersachs A, Musazada S, Schmitt CM. Management of anticoagulated patients in implant therapy: a clinical comparative study. Clin Oral Implants Res. 2016 Oct;27(10):1274-1282. doi: 10.1111/clr.12732. Epub 2015 Nov 23. — View Citation
Couto EV, Ballin CR, Sampaio CP, Maeda CA, Ballin CH, Dassi CS, Miura LY. Experimental study on the effects of bismuth subgallate on the inflammatory process and angiogenesis of the oral mucosa. Braz J Otorhinolaryngol. 2016 Jan-Feb;82(1):17-25. doi: 10.1 — View Citation
Daniels PR. Peri-procedural management of patients taking oral anticoagulants. BMJ. 2015 Jul 14;351:h2391. doi: 10.1136/bmj.h2391. Review. — View Citation
DeClerck D, Vinckier F, Vermylen J. Influence of anticoagulation on blood loss following dental extractions. J Dent Res. 1992 Feb;71(2):387-90. — View Citation
Dewan K, Bishop K, Muthukrishnan A. Management of patients on warfarin by general dental practitioners in South West Wales: continuing the audit cycle. Br Dent J. 2009 Feb 28;206(4):E8; discussion 214-5. doi: 10.1038/sj.bdj.2009.112. Epub 2009 Feb 13. — View Citation
Di Minno A, Frigerio B, Spadarella G, Ravani A, Sansaro D, Amato M, Kitzmiller JP, Pepi M, Tremoli E, Baldassarre D. Old and new oral anticoagulants: Food, herbal medicines and drug interactions. Blood Rev. 2017 Jul;31(4):193-203. doi: 10.1016/j.blre.2017 — View Citation
Diz P, Scully C, Sanz M. Dental implants in the medically compromised patient. J Dent. 2013 Mar;41(3):195-206. doi: 10.1016/j.jdent.2012.12.008. Epub 2013 Jan 11. Review. — View Citation
Doonquah L, Mitchell AD. Oral surgery for patients on anticoagulant therapy: current thoughts on patient management. Dent Clin North Am. 2012 Jan;56(1):25-41, vii. doi: 10.1016/j.cden.2011.06.002. Review. — View Citation
Dunn AS, Turpie AG. Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med. 2003 Apr 28;163(8):901-8. Review. — View Citation
Ferrieri GB, Castiglioni S, Carmagnola D, Cargnel M, Strohmenger L, Abati S. Oral surgery in patients on anticoagulant treatment without therapy interruption. J Oral Maxillofac Surg. 2007 Jun;65(6):1149-54. — View Citation
Garcia DA, Regan S, Henault LE, Upadhyay A, Baker J, Othman M, Hylek EM. Risk of thromboembolism with short-term interruption of warfarin therapy. Arch Intern Med. 2008 Jan 14;168(1):63-9. doi: 10.1001/archinternmed.2007.23. — View Citation
George C, Barras M, Coombes J, Winckel K. Unfractionated heparin dosing in obese patients. Int J Clin Pharm. 2020 Apr;42(2):462-473. doi: 10.1007/s11096-020-01004-5. Epub 2020 Mar 5. — View Citation
Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ; American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College o — View Citation
Halpern LR, Adams DR, Clarkson E. Treatment of the Dental Patient with Bleeding Dyscrasias: Etiologies and Management Options for Surgical Success in Practice. Dent Clin North Am. 2020 Apr;64(2):411-434. doi: 10.1016/j.cden.2019.12.010. Epub 2020 Jan 31. — View Citation
Kämmerer PW, Frerich B, Liese J, Schiegnitz E, Al-Nawas B. Oral surgery during therapy with anticoagulants-a systematic review. Clin Oral Investig. 2015 Mar;19(2):171-80. doi: 10.1007/s00784-014-1366-3. Epub 2014 Nov 22. Review. — View Citation
Keeling D, Baglin T, Tait C, Watson H, Perry D, Baglin C, Kitchen S, Makris M; British Committee for Standards in Haematology. Guidelines on oral anticoagulation with warfarin - fourth edition. Br J Haematol. 2011 Aug;154(3):311-24. doi: 10.1111/j.1365-2141.2011.08753.x. Epub 2011 Jun 14. Review. — View Citation
Ker K, Beecher D, Roberts I. Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev. 2013 Jul 23;(7):CD010562. doi: 10.1002/14651858.CD010562.pub2. Review. — View Citation
Kim SH, Tramontina VA, Papalexiou V, Luczyszyn SM. Bismuth subgallate as a topical hemostatic agent at palatal donor sites. Quintessence Int. 2010 Sep;41(8):645-649. — View Citation
Lopez MA, Andreasi Bassi M, Confalone L, Gaudio RM, Lombardo L, Lauritano D. Clinical outcome of 215 transmucosal implants with a conical connection: a retrospective study after 5-year follow-up. J Biol Regul Homeost Agents. 2016 Apr-Jun;30(2 Suppl 1):55- — View Citation
Madrid C, Sanz M. What influence do anticoagulants have on oral implant therapy? A systematic review. Clin Oral Implants Res. 2009 Sep;20 Suppl 4:96-106. doi: 10.1111/j.1600-0501.2009.01770.x. Review. — View Citation
Maniglia AJ, Kushner H, Cozzi L. Adenotonsillectomy. A safe outpatient procedure. Arch Otolaryngol Head Neck Surg. 1989 Jan;115(1):92-4. — View Citation
Mehra P, Cottrell DA, Bestgen SC, Booth DF. Management of heparin therapy in the high-risk, chronically anticoagulated, oral surgery patient: a review and a proposed nomogram. J Oral Maxillofac Surg. 2000 Feb;58(2):198-202. — View Citation
Ockerman A, Vanhaverbeke M, Miclotte I, Belmans A, Vanassche T, Politis C, Jacobs R, Verhamme P. Tranexamic acid to reduce bleeding after dental extraction in patients treated with non-vitamin K oral anticoagulants: design and rationale of the EXTRACT-NOA — View Citation
Patatanian E, Fugate SE. Hemostatic mouthwashes in anticoagulated patients undergoing dental extraction. Ann Pharmacother. 2006 Dec;40(12):2205-10. Epub 2006 Nov 7. Review. — View Citation
Perdigão JP, de Almeida PC, Rocha TD, Mota MR, Soares EC, Alves AP, Sousa FB. Postoperative bleeding after dental extraction in liver pretransplant patients. J Oral Maxillofac Surg. 2012 Mar;70(3):e177-84. doi: 10.1016/j.joms.2011.10.033. — View Citation
Proietti R, Porto I, Levi M, Leo A, Russo V, Kalfon E, Biondi-Zoccai G, Roux JF, Birnie DH, Essebag V. Risk of pocket hematoma in patients on chronic anticoagulation with warfarin undergoing electrophysiological device implantation: a comparison of differ — View Citation
Radoï L, Hajage D, Giboin C, Maman L, Monnet-Corti V, Descroix V, Mahé I. Perioperative management of oral anticoagulated patients undergoing an oral, implant, or periodontal procedure: a survey of practices of members of two dental scientific societies, — View Citation
Sannino G, Capparé P, Montemezzi P, Alfieri O, Pantaleo G, Gherlone E. Postoperative bleeding in patients taking oral anticoagulation therapy after 'All-on-four' rehabilitation: A case-control study. Int J Oral Implantol (Berl). 2020;13(1):77-87. — View Citation
Schmitt CM, Rusche B, Clemm R, Neukam FW, Buchbender M. Management of anticoagulated patients in dentoalveolar surgery: a clinical comparative study. Clin Oral Investig. 2020 Aug;24(8):2653-2662. doi: 10.1007/s00784-019-03124-3. Epub 2019 Nov 12. — View Citation
Scully C, Hobkirk J, Dios PD. Dental endosseous implants in the medically compromised patient. J Oral Rehabil. 2007 Aug;34(8):590-9. Review. — View Citation
Soares EC, Costa FW, Bezerra TP, Nogueira CB, de Barros Silva PG, Batista SH, Sousa FB, Sá Roriz Fonteles C. Postoperative hemostatic efficacy of gauze soaked in tranexamic acid, fibrin sponge, and dry gauze compression following dental extractions in ant — View Citation
Suresh V, Bishawi M, Manning MW, Patel C, Rogers J, Milano C, Schroder J, Daneshmand M, Powers D. Management of Patients With Left Ventricular Assist Devices Requiring Teeth Extraction: Is Halting Anticoagulation Appropriate? J Oral Maxillofac Surg. 2018 — View Citation
Thorisdottir H, Ratnoff OD, Maniglia AJ. Activation of Hageman factor (factor XII) by bismuth subgallate, a hemostatic agent. J Lab Clin Med. 1988 Oct;112(4):481-6. — View Citation
van Diermen DE, van der Waal I, Hoogvliets MW, Ong FN, Hoogstraten J. Survey response of oral and maxillofacial surgeons on invasive procedures in patients using antithrombotic medication. Int J Oral Maxillofac Surg. 2013 Apr;42(4):502-7. doi: 10.1016/j.i — View Citation
Wahl MJ. Demystifying medical complexities. J Calif Dent Assoc. 2000 Jul;28(7):510-8. Review. — View Citation
Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med. 1998 Aug 10-24;158(15):1610-6. Review. — View Citation
Weltman NJ, Al-Attar Y, Cheung J, Duncan DP, Katchky A, Azarpazhooh A, Abrahamyan L. MANAGEMENT OF DENTAL EXTRACTIONS IN PATIENTS TAKING WARFARIN AS ANTICOAGULANT TREATMENT: A SYSTEMATIC REVIEW. J Can Dent Assoc. 2015;81:f20. Review. — View Citation
Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT; — View Citation
Zanon E, Martinelli F, Bacci C, Cordioli G, Girolami A. Safety of dental extraction among consecutive patients on oral anticoagulant treatment managed using a specific dental management protocol. Blood Coagul Fibrinolysis. 2003 Jan;14(1):27-30. — View Citation
* Note: There are 48 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number of immediate postoperative bleeding events | 0: no bleeding; -1: mild bleeding defined as minor oozing from the wound incision controlled with compressive gauze only -2: moderate bleeding associated with the presence of large clots continuously disrupting the surgical area and requiring additional hemostatic measures; -3: severe bleeding requiring further medical control of coagulation | Within the first 30 minutes after surgery | |
Primary | Number of short-term bleeding events | 0: no bleeding; -1: mild bleeding defined as minor oozing from the wound incision controlled with compressive gauze only -2: moderate bleeding associated with the presence of large clots continuously disrupting the surgical area and requiring additional hemostatic measures; -3: severe bleeding requiring further medical control of coagulation | Within the first 5 days post-surgery | |
Primary | Number of presence of intraoral hematomas events | changes in mucosa color and edema (recorded as a dichotomous variable- yes/no). | On day 7 post-surgery | |
Primary | Number of presence of extraoral hematomas events | changes in skin color and edema (recorded as a dichotomous variable- yes/no). | On day 7 post-surgery |
Status | Clinical Trial | Phase | |
---|---|---|---|
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