Risk of Bleeding During Oral Surgery in Patients With Liver Cirrhosis: A Systematic Review With Meta-Analysis

Rech, Bruna de Oliveira; Tenório, Jefferson da Rocha; Medina, Janaina Braga; Gallottini, Marina; Pérez‐Sayáns, Mario; Ortega, Karem López

doi:10.1016/j.oooo.2020.04.672

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“…The incidence of bleeding episodes found in our study (24%) was higher than the frequency of these episodes reported in previous studies, which ranged from 1.7 to 23% [13,14]. In a recent systematic review, the authors concluded that patients with liver cirrhosis have a low risk of intraoperative and postoperative hemorrhage during oral surgery [15]. These differences may be explained by the variations in the liver disease stages, and the impact of the disease on the coagulation cascade [16].…”

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confidence: 64%

Hemorrhagic complications in individuals with liver disease submitted to minor oral surgery

Souza¹,

Rocha²,

Silva³

et al. 2022

Blood Coagulation &Amp; Fibrinolysis

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Individuals with chronic liver disease (CLD) have an increased risk of bleeding from thrombocytopenia and changes in hemostasis. The aim of this study was to evaluate the frequency of and the factors associated with the occurrence of bleeding in CLD patients who underwent dental surgical procedures. This was a retrospective study whose data were collected in a hospital dentistry service between 2010 and 2016. The patients were referred from the gastroenterology and liver transplantation services of a university hospital for dental treatment. The study followed the STROBE guidelines. Among the 71 surgical procedures performed, there were 17 (24%) perioperative and postoperative bleeding episodes, 14 of which were in pretransplant patients and 11 received blood transfusion before dental surgery. Individuals with a previous history of bleeding (PR = 2.67, CI = 1.07–6.67, P = 0.035) and those with a platelet count before surgery 50 × 109/l or less (PR = 7.48, CI = 1.70–32.86, P = 0.008) had a higher prevalence of perioperative and postoperative bleeding episodes than their peers without a previous history of bleeding, and those with platelet count greater than 50 × 109/l. The approach to individuals with CLD is complex and represents a challenge to the clinician. A careful anamnesis combined with laboratory screening of coagulation disorders appears to be useful to identify individuals at a major risk of bleeding. Studies identifying the predisposing factors of bleeding in CLD patients support well tolerated protocols for oral surgery in this group.

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