Invazivni stomatološki zahvati u pacijenata koji uzimaju nove oralne antikoagulanse

master's thesis

• Title (english): Invasive dental procedures in patients taking novel anticoagulants
• Author: Paula Vršić
• Mentor: Ivan Salarić (mentor)
• Committee member: Ivan Salarić (predsjednik povjerenstva)
• Committee member: Davor Brajdić (član povjerenstva)
• Committee member: Josip Biočić (član povjerenstva)
• Granter: University of Zagreb; School of Dental Medicine; (Department of Oral Surgery); Zagreb
• Defense date and country: 2022-09-23, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine; Oral Surgery

Abstract

Novi oralni antikoagulantni lijekovi u sve su češćoj uporabi kod pacijenata s rizikom od
nastanka tromboembolija. Njihova je primarna funkcija utjecaj na mehanizam koagulacije
blokadom na neki od čimbenika zgrušavanja krvi pritom onemogućujući nastanak krvnog
ugruška. Zbog stabilne farmakokinetike i dinamike nisu potrebne redovite kontrole zgrušavanja
krvi. NOAK­i se mogu podijeliti u dvije skupine: izravni inhibitori trombina u koje se ubraja
dabigatran i izravni inhibitori FXa u koje su ubrajaju apiksaban, rivaroksaban i edoksaban.
Invazivni stomatološki zahvati tijekom kojih se ne očekuje krvarenje ili je rizik od nastanka
produljenog krvarenja minimalan mogu se izvoditi bez prekidanja terapije NOAK­ima. Zahvati
koji imaju veći rizik od nastanka produljenog krvarenja zahtijevaju konzultacije o prekidanju
terapije sa nadležnim liječnikom koji ju je ordinirao. Bolesnici s određenim stupnjem renalnog
oštećenja također zahtijevaju modifikaciju doze ili prekid terapije zbog dužeg zadržavanja
djelatne tvari NOAK­a u krvnoj plazmi. Poželjno je nakon operacijskog zahvata primijeniti
nekoliko mjera lokalne hemostaze koje uz tamponadu sterilnom gazom uključuju moguće
postavljanje šavova i primjenu nekog antifibrinolitika i apsorbirajućeg spužvastog sredstva.

Abstract (english)

New oral anticoagulant drugs are being increasingly used in patients with a risk of
thromboembolism. The primary function of these drugs is the influence on the coagulation
mechanism by blocking some of the blood clotting factors and thereby preventing the formation
of a blood clot. Due to their stable pharmacokinetics and pharmacodynamics, there is no need
for regular blood clotting control. There are two groups of NOACs: direct thrombin inhibitors
which include dabigatran and direct FXa inhibitors which include apixaban, rivaroxaban and
edoxaban. Invasive dental procedures in which bleeding is not expected or procedures in which
the risk of prolonged bleeding is minimal can be performed without discontinuation of the
NOACs therapy. Procedures which have a high risk of prolonged bleeding demand
consultations about the discontinuation of the therapy with the competent doctor who has
prescribed it. Patients with a certain degree of renal impairment also need a dose modification
or therapy discontinuation due to the longer retention of the active substance of NOAK in the
blood plasma. After surgery, it is preferable to apply several measures of local haemostasis,
which, in addition to tamponade with sterile gauze, include the placement of sutures, and if
possible, the application of some antifibrinolytic and absorbent sponge agent.

• Keywords: oralnokirurški postupci; antikolagulansi; hemostaza; krvarenje
• Keywords (english): Oral Surgical Procedures; Anticoagulants; Hemostasis; Hemorrhage
• Language: croatian
• URN:NBN: urn:nbn:hr:127:914817
• Study programme: Title: dental medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-11-21 12:14:06