Thesis etd-10082022-104258 |
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Thesis type
Tesi di specializzazione (3 anni)
Author
MATTIOZZI, MARCO
URN
etd-10082022-104258
Thesis title
Outcome delle estrazioni dentali nei pazienti in terapia con anticoagulanti orali diretti (DOAC): studio clinico osservazionale prospettico
Department
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Course of study
CHIRURGIA ORALE
Supervisors
relatore Prof. Barone, Antonio
Keywords
- anticoagulant
- anticoagulante
- estrazione dentale
- tooth extraction
Graduation session start date
04/11/2022
Availability
Withheld
Release date
04/11/2025
Summary
Gli anticoagulanti orali sono una categoria di farmaci che include gli antagonisti della vitamina K e gli anticoagulanti orali diretti, anche conosciuti con le sigle DOAC o NAO. Questi farmaci sono usati per prevenire, trattare o ridurre il rischio tromboembolico nei pazienti affetti da: fibrillazione atriale, tromboembolia venosa, malattia ischemica cardiaca, ischemia cerebrovascolare, infarto miocardico e patologie valvolari. Recentemente, sono stati introdotti i Nuovi Anticoagulanti Orali (NAO) per semplificare e migliorare il management dei pazienti in terapia anticoagulante. Appartengono a questa categoria: Dabigatran, Apixaban, Rivaroxaban ed Edoxaban. Con l’aumento dell’età media della popolazione generale è anche in aumento il numero di pazienti che fanno uso di tali farmaci e che potrebbero necessitare di terapie chirurgiche odontoiatriche. Le estrazioni dentarie vengono classificate tra le procedure a basso rischio di sanguinamento. Per sanguinamento post-operatorio si intende quel sanguinamento che si verifica dopo 20 minuti di applicazione di garza a compressione. Considerando che il rischio di sanguinamento in pazienti in terapia anticoagulante è aumentato rispetto ai pazienti sani, il razionale del nostro studio è comprendere quali e quanti siano i casi di sanguinamento peri e postoperatorio in pazienti trattati con anticoagulanti orali ad azione diretta sottoposti ad estrazioni dentarie. Gli obiettivi secondari riguardano il comprendere quali variabili anamnestiche (come il farmaco assunto) e operatorie (numero di elementi dentari estratti) possano influenzare il rischio di sanguinamento peri e post-operatorio. Gli anticoagulanti orali diretti sono stati introdotti di recente, pertanto gli studi in letteratura sono recenti e ridotti soprattutto nel campione analizzato. Abbiamo così deciso di effettuare un nostro studio che valutasse tale situazione clinica. Sono stati arruolati in questo studio 49 pazienti che assumono questi nuovi anticoagulanti orali, giunti presso l'U.O. di Odontostomatologia e Chirurgia del Cavo Orale dell' A.O.U.P. per effettuare le cure necessarie. Questi pazienti hanno accettato di partecipare al nostro studio mediante un consenso informato debitamente firmato. Dopo aver effettuato gli interventi necessari e raccolto i dati in appositi Case Report Form, i dati sono stati inseriti in tabelle Excel e sottoposti ad analisi statistiche per mettere a confronto i dati del nostro campione e giungere cosi agli obiettivi prefissati del nostro studio.
Oral anticoagulants are a category of drugs that includes vitamin K antagonists and direct oral anticoagulants, also known as DOAC or NAO. These drugs are used to prevent, treat or reduce thromboembolic risk in patients with: atrial fibrillation, venous thromboembolism, ischemic heart disease, cerebrovascular ischaemia, myocardial infarction and valve disease. Recently, New Oral Anticoagulants (NAO) have been introduced to simplify and improve the management of patients on anticoagulant therapy. Belong to this category: Dabigatran, Apixaban, Rivaroxaban and Edoxaban. With the increase in the average age of the general population, the number of patients who use these drugs and who may need dental surgery is also increasing. Tooth extractions are classified as low-risk bleeding procedures. Post-operative bleeding refers to bleeding that occurs after 20 minutes of compressing gauze application. Considering that the risk of bleeding in patients on anticoagulant therapy is increased compared to healthy patients, the rationale of our study is understanding which and how many cases of peri and postoperative bleeding are in patients treated with direct acting oral anticoagulants undergoing dental extractions. The secondary objectives concern the understanding which anamnestic (such as the drug taken) and operative (number of extracted dental elements) variables can influence the risk of peri and post-operative bleeding. Direct oral anticoagulants have been introduced recently, therefore the studies in the literature are recent and reduced especially in the analyzed sample. We therefore decided to carry out our own study that evaluated this clinical situation. 49 patients taking these new oral anticoagulants were enrolled in this study and arrived at the U.O. Odontostomatologia e Chirurgia del Cavo Orale of the A.O.U.P. to carry out the necessary care. These patients agreed to participate in our study with a duly signed informed consent. After carrying out the necessary interventions and collecting the data in special Case Report Forms, the data were entered in Excel tables and subjected to statistical analysis to compare the data of our sample and thus reach the set objectives of our study.
Oral anticoagulants are a category of drugs that includes vitamin K antagonists and direct oral anticoagulants, also known as DOAC or NAO. These drugs are used to prevent, treat or reduce thromboembolic risk in patients with: atrial fibrillation, venous thromboembolism, ischemic heart disease, cerebrovascular ischaemia, myocardial infarction and valve disease. Recently, New Oral Anticoagulants (NAO) have been introduced to simplify and improve the management of patients on anticoagulant therapy. Belong to this category: Dabigatran, Apixaban, Rivaroxaban and Edoxaban. With the increase in the average age of the general population, the number of patients who use these drugs and who may need dental surgery is also increasing. Tooth extractions are classified as low-risk bleeding procedures. Post-operative bleeding refers to bleeding that occurs after 20 minutes of compressing gauze application. Considering that the risk of bleeding in patients on anticoagulant therapy is increased compared to healthy patients, the rationale of our study is understanding which and how many cases of peri and postoperative bleeding are in patients treated with direct acting oral anticoagulants undergoing dental extractions. The secondary objectives concern the understanding which anamnestic (such as the drug taken) and operative (number of extracted dental elements) variables can influence the risk of peri and post-operative bleeding. Direct oral anticoagulants have been introduced recently, therefore the studies in the literature are recent and reduced especially in the analyzed sample. We therefore decided to carry out our own study that evaluated this clinical situation. 49 patients taking these new oral anticoagulants were enrolled in this study and arrived at the U.O. Odontostomatologia e Chirurgia del Cavo Orale of the A.O.U.P. to carry out the necessary care. These patients agreed to participate in our study with a duly signed informed consent. After carrying out the necessary interventions and collecting the data in special Case Report Forms, the data were entered in Excel tables and subjected to statistical analysis to compare the data of our sample and thus reach the set objectives of our study.
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