No abstract

Antiplatelet and anticoagulant agentshave been extensively researched and developed as potential therapies in the prevention and management of arterial and venous thrombosis. On the other hand, antiplatelet and anticoagulant drugs have also been associated with an increase in the bleeding time and risk of postoperative hemorrhage. Because of this, some dentists still recommend the patient to stop the therapy for at least 3 days before any oral surgical procedure. However, stopping the use of these drugs exposes the patient to vascular problems, with the potential for significant morbidity. This article reviews the main antiplatelet and anticoagulant drugs in use today and explains the dental management of patients on these drugs, when subjected to minor oral surgery procedures. It can be concluded that the optimal INR value for dental surgical procedures is 2.5 because it minimizes the risk of either hemorrhage or thromboembolism. Nevertheless, minor oral surgical procedures, such as biopsies, tooth extraction and periodontal surgery, can safely be done with an INR lower than 4.0. (J. Oral Sci. 49, [253][254][255][256][257][258] 2007)

No abstract

Our goal was to determine a subset of patients at high risk of developing liver abscesses after local treatment of liver tumors (LTLT) and establish guidelines for the conduct of LTLT in the safest conditions in such patients. Five hundred sixty-one LTLT, 489 transhepatic arterial chemoembolizations (TAC, 10 hepatic embolizations, and 62 percutaneous intratumor injections (PIT), were retrospectively reviewed for liver parenchyma necrosis and abscess formation. Four patients developed abscesses, three after TAC and one after PIT. Despite broad-spectrum antibiotherapy, percutaneous drainage, and surgery, two patients died. A left hepatectomy was required in the other two patients for cure. All four patients had a carcinoid or a neuroendocrine pancreatic tumor. Three out of four patients had bilioenteric anastomoses, and the fourth had recently undergone cholecystectomy and papillotomy. A Lipiodol/doxorubicin mixture without any particulate embolization was injected in the three patients who developed abscesses after TAC. LTLT in patients with bilio enteric anastomosis or papillotomy and/or neuroendocrine or carcinoid tumor should be performed with strict precautions during the procedure and for peri-procedural care.

Our goal was to determine a subset of patients at high Although rare, these complications are usually severe. risk of developing liver abscesses after local treatment Therefore, it is worthwhile to define the subset of paof liver tumors (LTLT) and establish guidelines for the tients with a high likelihood of developing such compliconduct of LTLT in the safest conditions in such pa-cations.tients. Five hundred sixty-one LTLT, 489 transhepatic arterial chemoembolizations (TAC), 10 hepatic emboliza-PATIENTS AND METHODS tions, and 62 percutaneous intratumor injections (PIT), were retrospectively reviewed for liver parenchyma neWe reviewed the liver abscesses that occurred after thercrosis and abscess formation. Four patients developed apy during our last 5-year experience of 561 LTLT in 210 abscesses, three after TAC and one after PIT. Despite patients: 489 TAC, 10 hepatic artery embolizations, and 62 broad-spectrum antibiotherapy, percutaneous drainage, PIT. and surgery, two patients died. A left hepatectomy was TAC was performed in 181 patients, 44 of whom had carcirequired in the other two patients for cure. All four pa-noid tumor and 12 of whom had an islet cell carcinoma. We tients had a carcinoid or a neuroendocrine pancreatic performed 245 courses of TAC (1-7 courses/patient) for hepatumor. Three out of four patients had bilioenteric anas-tocellular carcinomas, 112 for metastases from carcinoid tutomoses, and the fourth had recently undergone chole-mors, 20 for islet cell carcinoma metastases, and 112 for varicystectomy and papillotomy. A Lipiodol/doxorubicin ous hepatic tumors. Intra-arterial injections were performed mixture without any particulate embolization was in-in the hepatic artery beyond the gastroduodenal artery or in jected in the three patients who developed abscesses the right and left branches of the hepatic artery. No superafter TAC. LTLT in patients with bilio enteric anastomo-selective treatments were performed. Doxorubicin (50 mg/ sis or papillotomy and/or neuroendocrine or carcinoid m 2 ; Adriblastine; Lab Pharmacia, Saint Quentin, France) or tumor should be performed with strict precautions dur-cisplatin (1-2 mg/kg; Cisplatyl; Lab Rhône Poulenc Rorer, ing the procedure and for peri-procedural care. (HEPA-Antony, France) were the most commonly used anticancer TOLOGY 1996;23:1436-1440.) drugs. They were always mixed with Lipiodol using the usual push-and-pull method with two syringes connected by a three-way stopcock. The amount of Lipiodol injected was°10Local treatment of liver tumors (LTLT), such as mL in all cases. Embolization was performed after the mixed transhepatic arterial chemoembolization (TAC) and drug/lipiodol injection, nearly always using Gelfoam pledgets percutaneous intratumor injection (PIT), is frequently (1-3 mm; Spongel; Lab Houde, France), until complete occluused. In our experience, as shown in the literature, sion of the hepatic artery. Gelfoam powder was used only LTLT rarely induces severe complications, as long as when a coaxial catheter was required for cathete...