Lokal Anestezi Altında Oral Cerrahi Prosedür Uygulanan Hastaların Preoperatif Koagülasyon Değerlerinin Araştırılması

Amaç: Bu çalışmanın amacı lokal anestezi altında oral cerrahi işlem geçiren hastaları preoperatif koagülasyon değerlerinin araştırılmasıdır.Gereç ve Yöntem: Çalışmaya 2017-2018 tarihleri arasında Adıyaman Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi Kliniği’ne çeşitli nedenlerden dolayı başvuran ve yapılan muayene sonucu kendisine lokal anestezi altında cerrahi girişim uygulanan 1598 hasta dahil edildi. Hastalara ait yaş, cinsiyet ve aktif parsiyel tromboplastin zamanı (APTT), protrombin zamanı (PT) ve uluslararası normalleştirilmiş oran (INR) gibi koagülasyon değerleri kaydedildi ve istatistiksel olarak analiz edildi.Bulgular: Çalışmaya dahil edilen hastaların yaş aralığı 11-92 arasında değişmekteydi ve yaş ortalaması 30,51±11,09 idi. Bu hastaların %63,06’sı (n=1007) kadın, %36,94’ü (n=591) erkekti. Cinsiyete göre dağılımda başvuran toplam kadın hasta sayısı erkeklere kıyasla daha fazlaydı. Tüm hastalar alt yaş grupları (0-20, 21-40, 41-60, >60) bakımından incelendiğinde her iki cinsiyette özellikle 0-20 ile 21-40 yaş gruplarında istatistiksel olarak anlamlı farklılık bulundu (p<0.05). 40 yaş üstü gruplarda ise anlamlı farklılık bulunmadı (p>0.05). İncelenen koagülasyon değerlerinin hepsinde normal sınırların dışında seyreden değerler görüldü. Bunlardan APTT ve PT (%) değerlerinde düşük değerler; INR ve PT (sn) değerlerinde ise yüksek değerler sayıca daha fazla bulundu. Normal olmayan bu değerler cinsiyet bakımından incelendiğinde PT (%) hariç diğerleri erkeklere nazaran kadınlarda istatistiksel olarak anlamlı şekilde daha fazla görüldüğü bulundu. Dört koagülasyon parametresine ait normal olmayan bu değerler yaş grupları bakımından ise istatistiksel olarak anlamlı şekilde en fazla 21-40 yaş arasında görüldüğü tespit edildi (p<0,001). Sonuç: Lokal uygulanan cerrahi işlemler öncesinde preoperatif koagülasyon testlerinin alınması özellikle detaylı tıbbi anamnez alınamayan hastalarda önem arz etmektedir.

Anahtar Kelimeler:

APTT, INR, PT, preoperatif koagülasyon testleri, oral cerrahi

The Investigation Preoperative Coagulation Values of Patients Undergoing Oral Surgical Procedure Under Local Anesthesia

Objective: The aim in this study was to investigate preoperative coagulation values of patients undergoing oral surgery under local anesthesia.Material and Method: The study included 1598 patients who presented to the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry at Adıyaman University between 2017 and 2018 for various reasons and underwent surgery under local anesthesia based on examination. The patients’ age and gender as well as their coagulation values such as activated partial thromboplastin time (APTT), prothrombin time (PT) and international normalized ratio (INR) were recorded and analyzed statistically.Results: The age range of the patients included in the study ranged between 11 and 92, and their mean age was 30.51 ± 11.09. Of these patients, 63.06% (n = 1007) were female, and 36.94% (n = 591) were male. The total number of female patients admitted was more than that of the male patients in terms of the distribution by gender. When the number of patients admitted were examined in terms of age groups (0–20, 21–40, 41–60, > 60), statistically significant differences were found especially between the ages 0–20 and 21–40 in both gender (p <0.05). No significant differences were found in groups over the age of 40 (p > 0.05). Values outside the normal range were observed in all of the coagulation values examined. Among these, APTT and PT (%) values that were lower than the normal and INR and PT (s) values that were higher than the normal were found to prevail. An examination of these abnormal values in terms of gender revealed that the values other than PT (%) were found to be statistically significantly higher in women, compared to men. In terms of age groups, these abnormal values belonging to the four coagulation parameters were found to be statistically significantly the highest among the people who were 21–40 years old (p < 0.001).Conclusion: Taking preoperative coagulation tests prior to locally applied surgical procedures is especially important in patients for whom detailed medical history cannot be obtained.

Keywords:

APTT, INR, PT, preoperative coagulation tests, oral surgery,

PDF

___

1. Rodgers GM, Bithell TC. The diagnostic approach to the bleeding disorders. In: Lee GR, Foerster J, Lukens J, Paraskevas F, Greer JP, Rodgers GM, Eds. Wintrobe’s Clinical Hematology, Lippincott Williams & Wilkins, 1999: 1557-1578.
2. Seligsohn U, Coller BS. Classification, clinical manifestations and evaluation of disorders of hemostasis. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, Seligsohn U, Eds. William’s Hematology, McGraw Hill, 2001: 1471-1478.
3. Roizen MF, Foss JF, Ficsher SP. Preoperative evaluation. In: Miller RD Eds. Anesthesia, Churchill Livingstone, 2000: 824-883.
4. Finegan BA, Rashiq S, McAlister FA, O'Connor P. Selective ordering of preoperative investigations by anesthesiologists reduces the number and cost of tests. Can J Anaesth 2005; 52: 575-580.
5. Imasogie N, Wong DT, Luk K, Chung F. Elimination of routine testing in patients undergoing cataract surgery allows substantial saving in laboratory costs. A brief report. Can J Anaesth 2003; 50: 246-248.
6. Coskunses FM, Dogan O. Dental management of patients with bleeding disorders. Cumhuriyet Dent J 2013; 16: 83-90.
7. Nardella A, Pechet L, Synder LM. Continuous improvement, quality control, and cost containment in clinical laboratory testing. Effects of establishing and implementing guidelines for preoperative tests. Arch Pathol Lab Med 1995; 119: 518-522.
8. Dzankic S, Pastor D, Gonzalez C, Leung JM. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth Analg 2001; 93: 301-308.
9. Francis CW, Kaplan KL. Hematologic problems in the surgical patient: Bleeding and thrombosis. In: Hoffman R, Benz EJ, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P Eds. Hematology Basic Principles and Practice, Churchill Livingstone, 2000: 2381-2391.
10. Adams JG Jr, Weigelt JA, Poulos E. Usefulness of preoperative laboratory assessment of patients undergoing elective herniorrhaphy. Arch Surg 1992; 127: 801-805.
11. Kaplan EB, Sheiner LB, Boeckmann AJ, Roizen MF, Beal SL, Cohen SN, et al. The usefulnes of preoperative laboratory screening. JAMA 1985; 253: 3576-3581.
12. Perez A, Planell J, Bacardaz C, Hounie A, Franci J, Brotons C, et al. Value of routine preoperative tests: a multicentre atudy in four general hospitals. Br J Anaesth 1995; 74: 250-256.
13. Asaf T, Reuveni H, Yermiahu T, Leiberman A, Gurman G, Porat A, et al. The need for routine pre-operative coagulation screening tests (prothrombin time PT/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy. Int J Ped Otorhinolaryngol 2001; 61: 217-222.
14. Close HL, Kryzer TC, Nowlin JH, Alving BM. Hemostatic assessment of patients before tonsillectomy: a prospective study. Otolaryngol Head Neck Surg 1994; 111: 733-738.
15. Houry S, Georgeac C, Hay JM, Fingerhut A, Boudet MJ. A prospective multi-center evaluation of preoperative hemostatic screening tests. The French Associations for Surgical Research. Am J Surg 1995; 170: 19-23.
16. Burk CD, Miller L, Handler SD, Cohen AR. Preoperative history and coagulation screening in children undergoing tonsillectomy. Pediatrics 1992; 89: 691-695.
17. World Health Organization (WHO). WHO Expert Committee on Biological Standardization-Thirty-Third report. Annex 3, WHO Technical Report Series, no.687-Requirements for thromboplastins and plasma used to control oral anticoagulant therapy,198318. Magnette A. Chatelain M, Chatelain B, Ten Cate H, Mullier F. Pre-analytical issues in the haemostasis laboratory: guidance for the clinical laboratories. Thromb J 2016; 14: 49.
19. Funk DM. Coagulation assays and anticoagulant monitoring. Haematology Am Soc Hematol Educ Program 2012; 2012: 460-465.
20. Lu SY, Lin LH, Hsue SS. Management of dental extractions in patients on warfarin and antiplatelet therapy. J Fromos Med Assoc. 2018; 117: 979-986.
21. van Diermen DE, van der Waal I, Hoogstraten J. Management recommednations for invasive dental treatment in patients using oral antithrombotic medication, including novel oral anticoagulants. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116: 709-716.
22. Douketis JD, Spuropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of athithrombotic therapy: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141: e326S-e350S.
23. Sadler JE, Manucci PM, Berntorp E, Bochkov N, Boulyjenkov V, Ginsburg D, et al. Impact, diagnosis and treatment of von Willebrand disease. Thromb Haemost 2000; 84: 160-174.
24. Bolton-Maggs PHB, Perry DJ, Chalmers EA, Parapia LA, Wilde JT, Williams MD, et al. The rare coagulation disorders-review with guidlines for management from the United Kingdom Haemophilia Centre Doctors Organisation. Haemophilia 2004; 10: 593-628.
25. Beloeil H, Ruchard D, Dreniak N, Molliex S. Overuse of preoperative labortory coagulation testing and ABO blood typing: a French national study. Br J Anaesth 2017; 119: 1186-1193.
26. Ng KF, Lai KW, Tsang SF. Value of preoperative coagulation tests: reappraisal of majör noncardiac surgery. World J Surg 2002; 26: 515-520.
27. Saw PH, Reynolds S, Gunawardena S, Krishnamurti L, Ritchey AK. The prevalence of bleeding disorders among healthy pediatric patients with abnormal preprocedural coagulation studies. J Pediatr Hematol Oncol 2008; 30: 135-141.
28. Buldu S, Halıcı C, Narin F, Elmalı F. Determination of Pediatric Reference Intervals for Three Coagulation Tests in Widespread Use for City of Kayseri Population. Turk J Biochem 2012; 37: 362-367.
29. Laffan MA, Lester W, O’Donnell JS, Will A, Tait RC, Goodeve A. The diagnosis and management of won Willebrand disease: a United Kingdom Haemophilia Centre Doctors Organization guideline approved by the British Committee for Standards in Haematology. Br J Haematol 2014; 167: 453-465.
30. Nagarakanti S, Sappati H, Gunupati S, Ramesh Reddy BV, Chava VK.. Dental management of a patient with incidentally detected hemophilia: Report of a clinical case. J Indian Soc Periodontol 2019; 23: 281-283.