EVALUATION OF COLLOIDAL SILVER GELATIN SPONGE (GELATAMP) IN PATIENTS RECEIVING ANTICOAGULANT AFTER TOOTH EXTRACTION (CLINICAL STUDY)

Document Type : Original Article

Authors

1 B.D.S. Faculty of Dentistry Jordan University of science and technology

2 Professor of Oral & Maxillofacial Surgery, Faculty of Dentistry, Alexandria University

3 Lecturer of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University

4 Assistant professor of Cardiology, Faculty of Medicine, Alexandria University

Abstract

Introduction: Patients with a history of heart attack or stroke may take anticoagulant. Because these are anticoagulant medications, bleeding time after dental treatments, may be prolonged. Gelatamp is made of 95% foam gelatin sponge and 5% finely dispersed colloidal silver. Gelatamp has the great advantages of both haemostatic and bactericidal effect. Objectives: To evaluate clinically the use of Gelatamp to avoid postoperative dry socket and bleeding in patients receiving anticoagulant therapy without altering the medication dosage. Materials and methods: This study was conducted on fifty patients indicated for teeth extraction divided into two equal groups. Study group consisting of 25 patients who received their medicine as usual and extraction was done followed by insertion of gelatamp in the socket and supported with heavy pack. Control group consisting of 25 patients who stopped their medicine until INR reached 1.6 and Prothrombin activity more than 60% after that extraction was done and the socket was supported with heavy pack. The patients were monitored for 24 hours in both groups. Results: Adequate socket healing was detected in all patients of both groups. Conclusion: Gelatamp is an effective material as local hemostatic agent after extraction for anticoagulant patients (within the therapeutic range of INR) without interruption of their medicine.

Keywords

References

1. Jaffer AK, Brotman DJ, Chukwumerije N. When patients on warfarin need surgery. Cleve Clin J Med. 2003;70:973-84.
2. Hirsh J, Dalen J, Anderson DR, Poller L, Bussey H, Ansell J, et al. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest. 2001;119:8S-21S.
3. Katzung B. Basic and Clinical Pharmacology. San Mateo, CA: Appleton & Lange; 1989. p 410.
4. White RH, McKittrick T, Hutchinson R, Twitchell J. Temporary discontinuation of warfarin therapy: changes in the international normalized ratio. Ann Intern Med. 1995;122:40-2.
5. Grip L, Blombäck M, Schulman S. Hypercoagulable state and thromboembolism following warfarin withdrawal in post-myocardial-infarctionpatients. Eur Heart J. 1991;12:1225-33.
6. Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW. Can warfarin be continued during dental extraction? Results of a randomized controlled trial. Br J Oral Maxillofac Surg. 2002;40:248-52.
7. Hirsh J, Fuster V, Ansell J, Halperin JL. American Heart Association/American College of Cardiology foundation guide to warfarin therapy. J Am Coll Cardiol. 2003;41:1633-52.
8. Malmquist JP, Clemens SC, Oien HJ, Wilson SL. Hemostasis of Oral Surgery Wounds With the HemCon Dental Dressing. J Oral Maxillofac Surg. 2008;66:1177-83.
9. Gall RM, Witterick IJ, Shargill NS, Hawke M. Control of bleeding in endoscopic sinus surgery: use of a novel gelatin-based hemostatic agent. J Otolaryngol. 2002;31:271-4.
10. Hassan O, Allah EA, Fouda A. Evaluation of the role of gelatamp in comparison with gelatine sponge on postoperative complications following odontoctomy of impacted mandibular third molar. Dent J. 2011;57:3659.
11. Qin Y. Silver-containing alginate fibres and dressings. Int Wound J. 2005;2:172-6.
12. Hermans MH. Silver-containing dressings and the need for evidence. Am J Nurs. 2006;106:60-8.
13. Chopra I. The increasing use of silver-based products as antimicrobial agents: a useful development or a cause for concern? J Antimicrob Chemother. 2007;59:587-90.
14. Cai YH, Lu CS. A clinical study of gelatamp colloidal silver gelatin sponge on preventing the complication of teeth extraction. Hua Xi Kou Qiang Yi Xue Za Zhi. 2008;26:519-21.
15. Monaco G, Daprile G, Tavernese L, Corinaldesi G, Marchetti C. Mandibular third molar removal in young patients: an evaluation of 2 different flap designs. J Oral Maxillofac Surg. 2009;67:15-21.
16. Pasqualini D, Cocero N, Castella A, Mela L, Bracco P. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study. Int J Oral Maxillofac Surg. 2005;34:52-7.
17. Ziffer AM, Scopp IW, Beck J, Berger AR. Profound bleeding after dental extraction during dicumarol therapy. N Engl J Med. 1957;256:351-3.
18. Little JW, Falace DA. Dental management of the medically compromised patient. St Louis: CV Mosby; 1997. pp. 486-8.
19. Blinder D, Ardekian L, Peleg M, Martinowitz U, Taicher S. Oral surgical procedures in patients on anticoagulant therapy. Harefuah. 1996;130:681-3.
20. Aframian DJ, Lalla RV, Pererson DE. Management of dental patients taking common hemostasis altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:S45.e1-115.
21. Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW. Can warfarin be continued during dental extractions? Results of a randomized controlled trial. Br J Oral & Maxillofac Surg. 2002;40:248-52.
22. Cannon PD, Dharmar VT. Minor oral surgery procedures in patients on oral anticoagulants - a controlled study. Aus Dent J. 2003;48:115-8.
23. Pereira CM, Gasparetto PF, Carneiro DS, Corrêa ME, Souza CA. Tooth extraction in patients on oral anticoagulants: prospective study conducted in 108 brazilian patients. ISRN Dent. 2011;2011:203619.
24. Morimoto Y, Niwa H. On the use of prothrombin complex concentrate in patients with coagulopathy requiring tooth extraction. Oral Med Oral Pathol Oral Radiol Endod. 2010;110:e7-e10.
25. Beirne OR, Koehler JR. Surgical management of patients on warfarin sodium. J Oral Maxillofac Surg. 1996;54:1115-8.
26. Wahl MJ. Myths of dental surgery in patients receiving anticoagulant therapy. J Am Dent Assoc. 2000;131:77- 81.
27. Bajkin BV, Popovic SL, Selakovic SD. Randomized, Prospective Trial Comparing Bridging Therapy Using Low-Molecular-Weight Heparin With Maintenance of Oral Anticoagulation During Extraction of Teeth. J Oral Maxillofac Surg. 2009;67:990-5.
28. Levine MN, Hirsh J, Gent M, Turpie AG, Weitz J, Ginsberg J, et al. Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis. Thromb Haemost. 1995;74:606-11.
29. Malmquist JP, Clemens SC, Oien HJ, Wilson SL. Hemostasis of Oral Surgery Wounds With the HemCon Dental Dressing. J Oral Maxillofac Surg. 2008;66:1177-83.
30. Al-Mubarak S, Al-Ali N, Abou-Rass M, Al-Sohail A, Robert A, Al-Zoman K, et al. Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy. Br Dent J. 2007;203:15.

Files

Share

How to cite

Statistics