Bleeding disorders dentistry

Bleeding disorders

د. محمد حارث الساعاتي

bleeding disorders can be classified into 2 categories :

1. Platelet defects .
2. Coagulation defects

* Platelet defects :

a. Defect in the number of platelets
( thrombocytopenia ).
b. Defect in the function of platelets
( thrombosthenia)

* Causes of thrombocytopenia :

1. Bone marrow diseases like aplastic anemia , leukemia…
2. Drugs : chemotherapy.
3. Autoimmune .
4. Congenital .
* Causes of thrombosthenia:
1. Systemic diseases like uremia
2. Congenital .
3. Antiplatelet drugs .


* Coagulation defects :
When there is deficiency of coagulation factors e.g. hemophilia A ( factor VIII deficiency) , hemophilia B ( factor IX deficiency ) , factor VII deficiency ..etc.
Coagulation defects can also occur secondary to systemic diseases like liver failure .

Approach to bleeding tendency :

1. History : site of bleeding , duration , family history , past history of bleeding following dental extraction or other dental procedures , drug history ( aspirin , clopidogrel , heparin , warfarin ..) .
2. Examination .
3. Investigation ( platelet count , prothrombin time , activated partial thromboplastin time , bleeding time …)










Approach to patients taking antiplatelets or anticoagulation therapy :

* Assess the dental procedure whether it is high risk of bleeding or low risk of bleeding .
* Evaluate the patient status ( comorbidity , need for his drugs ..)
* Consultation to physicians .

* Dental procedures with low risk of bleeding :

- Scaling
- Polishing
- Local anesthetic injections
- Simple uncomplicated extraction
- Biopsies

Dental procedure with high risk f bleeding :

1. Extensive maxillofacial surgery .
2. Multiple extractions
3. Major periodontal surgery
4. Alveolar surgery ( bone removal .

Anticoagulation ( heparin , warfarin)

Continue anticoagulation with minor procedures & low risk of bleeding .
Discontinue with major dental procedures & high risk of bleeding .
( warfarin stopped 3-5 days before the major procedures , iv heparin stopped 4-6 hours before the procedures , s.c. heparin 12- 24 hours )
** in high risk patient ( e.g. cardiac disease , valve diseases ) when u stop warfarin , bridging with heparin is indicated !.

Antiplatelets ( aspirin , clopidogrel )

if the patient has recent cardiac stent or had recent myocardial infarction , he may need to continue the drugs .
Minor surgery : continue treatment
Major surgery : discontinue 5-7 days before the surgery ..
**( if the patient has stent & he is on 2 antiplatelet & the procedure was urgent , discontinue clopidogrel , continue aspirin ) .

Thank

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