Background: Dentoalveolar procedures in immune thrombocytopenia (ITP) pose a risk of bleeding, due to thrombocytopenia, and infection, due to immunosuppressive treatments.

Aims: To systematically review the safety and management of dentoalveolar procedures in ITP patients in order to create practical recommendations.

Methods: Pubmed, Embase, Cochrane and Cinahl were searched. All original studies with surgical and non-surgical dentoalveolar procedures (including tooth extractions, scaling, and periodontal and endodontic surgery) in adult and pediatric patients with known primary ITP at the time of procedure were included. Details on bleeding- and infection-related outcomes were recorded, including the therapeutic strategies. Clinically relevant bleeding was defined as needing treatment or medical attention.

Results: Eighteen articles were included, of which twelve case reports/series. Overall, the quality of the available evidence was poor. Outcomes and administered therapies (including hemostatic therapies and prophylactic antibiotics) were not systematically reported. At least 118 dentoalveolar procedures in 94 ITP patients were described. The range of preoperative platelet count was 2-412*10⁹/L. Two clinically relevant bleedings were reported in the same patient, of which one life-threatening. Strategies used to minimalize the risk of bleeding were heterogeneous and included therapies to increase platelet count, antifibrinolytics, local measures and minimal invasive techniques. Reports on the occurrence of bleedings due to anesthetics or infection were lacking.

Conclusions: It appears that clinically relevant bleeding complications after dentoalveolar procedures in ITP patients occur rarely, based on low quality data. Reported therapeutic strategies to prevent bleedings are heterogeneous. Prospective and controlled studies are needed to evaluate safety of dentoalveolar procedures in patients with low platelet counts and to investigate the efficacy of therapeutic interventions. We propose practical recommendations to manage dentoalveolar procedures in ITP patients based on the best available evidence and our single-center clinical experience.

« Back to ISTH 2021 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/dentoalveolar-procedures-in-immune-thrombocytopenia-systematic-review-and-practical-recommendations/