Assessment of bleeding risk in elderly patients with comorbid pathology in preparation for dental implantation

Aim of the study. To develop a system for assessing the risk of bleeding in patients with comorbid cardiovascular pathology requiring anticoagulants and/or blood antiplatelet agents in preparation for dental implantation.

Material and methods. The study included 135 elderly patients of both sexes with cardiovascular pathology in preparation for dental implantation. Prothrombin time, International Normalized Ratio (INR), and thrombocrit were determined in venous and gingival blood.

Results. In patients of the clinical group, the prothrombin time and INR values for platelet-poor plasma and gingival blood did not differ (p>0.05). Since platelet-poor plasma and capillary blood differ in the percentage of platelets, it is advisable to introduce an appropriate correction factor when using gingival blood to control hemostasis. To calculate the correction factor (КРst) for thrombocrit (PCT), the following formula was developed using the regression analysis method: КРst = -0.06×PCT + 1.2. The INR value in gingival blood was multiplied by the correction factor КРst. In patients with hemorrhagic complications, in contrast to patients with an uncomplicated postoperative period, the INR value in gingival capillary blood adjusted for thrombocrit was higher (p=0.021), and the thrombocrit in the blood was lower (p=0.038). If the INR value in gingival capillary blood adjusted for thrombocrit is higher than 1.29, then the risk of bleeding during dental implantation is high (diagnostic sensitivity 81.25%, specificity 84.9%).

Conclusion. A high risk of bleeding during preparation of elderly patients with cardiovascular pathology for dental implantation is a rationale for discontinuing anticoagulants and/or antiplatelet agents during preparation and dental treatment. 

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