Sandu et al identified factors predictive of bleeding after a dental extraction in a patient with thrombocytopenia. The authors are from Brigham and Women’s Hospital and Harvard School of Dental Medicine in Boston.
Patient selection: status post dental extraction; platelet count < 150,000 per µL
Moderate thrombocytopenia: 50,000 to 100,000 per µL
Severe thrombocytopenia: < 50,000 per µL
Protocol:
(1) comprehensive medical evaluation
(2) thorough surgical planning
(3) local hemostatic measures (topical tranexamic acid or aminocaproic acid)
(4) closure with sutures after extraction
Prophylactic platelet transfusion prior to surgery if platelet count < 30,000 per µL is controversial.
Risk factors for bleeding:
(1) surgical extraction
(2) multiple number of extractions
(3) comorbid coagulopathy (with abnormal INR)
For patients with moderate or severe thrombocytopenia, the platelet count did not have a statistically significant effect on bleeding outcome.
