dr rahul vc tiwari - oral & maxillofacial surgery - sibar institute of dental sciences, gunutr,...

05/02/2023 12:14:05 AM RT/JC/1/OS IN LIVER TRANSPLANT PT./30 1

05/02/2023 12:14:05 AM RT/JC/1/OS IN LIVER TRANSPLANT PT./30

Oral surgery in liver transplant candidates: a retrospective study on delayed bleedingand other complications

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About the Journal

Journal Name: Oral Surgery, Oral Medicine,

Oral Pathology and Oral

Radiology

Periodicity of journal: Monthly

• Editor in Chief: R Bryan

Bell

• Publisher’s name: Thomas

Reuters Ltd.

• ISSN NO Print : 0265 -539X

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About the Journal contd..

• Impact factor:

• Peer review:

• Indexation:

0.732

Yes

Pubmed, Google scholar,

EBSCO

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• Date of publication: 1st May 2016

• Volume:

121

• Issue: 5

• Type of article: Research

Article

• Page numbers: 490-495

• Received: 25 August 2015

• Accepted: 24 January 2016

About the Article

5

9 months


About the Article contd..

• Author names :

• Institutional

Attachments :

• Designations :

• Keywords :

Jaana helenius hietala& its associates

Helinski, finland

Not MentionedDental infections,Heamorrhage,Tooth extraction,Liver cirrhosis

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• Study design : Mentioned.

• Common terms : Common terms were

used.

Title :

Oral surgery in liver transplant candidates: a

retrospective study on delayed bleeding and other

complications

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Running Title:

Bleeding following oral surgery in liver transplant candidates

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Abstract:

Informative :

Yes

Balanced summary of what

was done and what was found:

Structured

Abstract.9


Introduction:

Scientific

background:

Approach:

Mentioned

Seminar approach

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Guggenheimer et al 2003, Helenius heitala j et al 2013

Pre-transplant dental treatment is a prerequisite in many liver transplantation pt.to prevent post-transplant infectious complications, such as bacteremia and sepsis, which could be fatal in immunocompromised patients.

Helenius heitala j et al 2012, ward BB et al 2006

In particular, patients with chronic liver disease (CLD) have shown poor oral health with a high prevalence of dental infections in pre-LT dental evaluations. Patients with CLD also run a high risk of bleeding after oral surgery, due to CLD-associated coagulopathy

Perdigao JP et al 2012, Stanca CM et al 2010

previous studies were limited by small cohorts (9 to 90 patients), and those patients often had well-compensated CLD

Valerian 2007, Hong CH 2012

Earlier studies that specifically studied LT candidates, that is, patients with advanced or end-stage liver disease, included only 23 to 36 patients.

REV

IEW

OF

LITE

RAT

UR

E


Objectives:

Untreated dental infections pose a threat for immunocompromised

liver transplant (LT) recipients.

Therefore, pretransplant dental evaluations are recommended.

However, risk of bleeding should be considered among patients with

end-stage liver disease and prophylactic blood transfusions may be

used to prevent bleeding.

We retrospectively studied the incidence of and risk factors for oral

surgery-related bleeding in candidates for LT and hypothesized that

complications may occur despite pre- and peri-operative hemostatic

actions.

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Pre-

specified

hypotheses :

Mentioned

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Study design:

One hundred thirty four patients who had tooth extractions

by oral and maxillofacial surgeons pre-LT

were studied.

The primary endpoint was bleeding between 24 h and 2

weeks post-extraction. Bleeding risk was analyzed by the

pre-operative platelet (PLT) count and INR.

Invasiveness of procedures, severity of liver disease, PLT,

INR, prophylactic transfusions of PLT, fresh frozen plasma,

and tranexamic acid (TA) were included in uni- and

multivariate logistic regression analysis to further assess

risk.14


Sampling technique:

Study design:

Setting Locations:

Relevant dates

Periods of

recruitment:

Statistical analysis:

Statistical test:

Not mentioned

Retrospective study

Helsinki, Finland

2000-2006 (toto of 306- dental evaluation 263 in that 134) = -129?

SPSS.ver.17Chi-square,Mann-Whitney testUnivariate logistic regressionMultivariable logistic regression

Materials and Methods

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Variables:

Dependent: bleeding incidence,

platelet level

Independent: tooth extractions

INR

MELD score

PPT

Age

Gender

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ResultsTwelve patients exhibited minor bleeding; four despite PLT>100x109/L and INR<1.5.

Increased bleeding associated with INR and prophylactic transfusions by univariate analysis;

by multivariate analyses, prophylactic TA and PLT remained significant.


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Discussion


Given

Limitations:

Overall

interpretation

of results :

Generalizabili

ty:

Mentioned

Given.

Not Discussed.

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Observed Limitations

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• Retrospective

• Only INR & Platelets were considered

• Results partly confirm the hypothesis

• No other complications are mentioned

• Only males

• No reason for age groups


Bias:

Ethical clearance:

Funding:

Not mentioned

Institutional review board approval from Helinski

Mentioned

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Conclusion is meaningful and is based on aim of the study.i.e risk of bleeding is difficult to predict in patients with cirrhosis but, on the other hand, frequency of delayed bleeding is in general low.

Acknowledgement were not mentioned.Recommendation were not mentioned.

Finally, results suggest that use of prophylactic blood coagulation factors requires individual assessment.

CRITICAL APPRAISAL OF CONCLUSION

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Suggested Title:

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Delayed bleeding in tooth extraction

males among 45-51 year old with liver

transplant in Helniski : A

Restrospective study.

OR

Retrospective study of delayed

bleeding after tooth extraction in 45-

50 year old age group who underwent

liver transplant in helinski.


23 references in total.

References accessed were : 14

References are in HARVARD .

Number of articles reflecting the study: 09

Reference before 2006: 10

Reference after 2006: 13

Introduction: 8 were cited

Materials and methods: NONE

Discussion: 15 were cited

CRITICAL APPRAISAL OF REFERENCES

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Statement of clinical relevance

INR and platelet count do not reliably predict bleeding after tooth extractions in liver transplant candidates due to rebalanced hemostasis.

Lisman T et al. 2010 . Rebalanced hemostasis in patients with liver diseases: evidence and clinical consequences.

Hence, routine prophylactic replacement therapy may be ineffective.

Alternatively, local hemostatic measures and close post-operative follow-up by a skilled clinician are recommended.


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dr rahul vc tiwari - oral & maxillofacial surgery - sibar institute of dental sciences, gunutr,...

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