160 Factors arising bleeding risk in dental surgery in patients treated with antivitamin K

Background In dental surgery, to take charge of heart disease patients treated with antivitamin K remains a common practice problem. Objective To research the factors which increase bleeding after dental extractions in patients treated by acenocoumarol. Material and methods Cohort study in which dental extractions are realized in heart disease patients treated by acenocoumarol, with an International Normalized Ratio (INR1) the day before the act between 2.00 and 4.50, using in all cases the local hemostatic measures : oxycellulose mesh (surgicel*) + sutures + compression gutter. The day of extraction, a pre-operative INR control (INR2) was systematic. The degree of dental traumatism corresponded to the extracted root number / session. The results are expressed with confidence intervals at 95%. Results 229 extraction sessions are realized in 135 patients, 50.32 + 2.12 years old with a 1.25 sex ratio, an extractions number / subject / session of 1.96 + 0.23 teeth and a degree of dental traumatism of 2.89 + 0.24. The INR1 and INR2 were respectively of 3.30 + 1.10 and 3.40 + 1.59. Bleeding complicated 9 extraction sessions (3.93%) and occurred after the 48 th hour in 4 cases (44.44%). In the bleeding group, INR2 was 3.33 + 7.02 against 3.40 + 1.64 in absence of haemorrhage, p = 0.86. The degree of dental traumatism was 4.89 + 3.11 in cases of bleeding against 2.80 + 0.22, p = 0.02. Conclusion In heart disease patients treated by acenocoumarol, it's the degree of dental traumatism which was the hemorrhagic factor, not the INR pre-operative value.