Oral surgery procedures in patients on anticoagulants. Preliminary report

Wstęp: U chorych, którzy przyjmują doustne leki przeciwzakrzepowe, zabiegi z zakresu chirurgii jamy ustnej, szczególnie ekstrakcje zębów, są wykonywane powszechnie. Ponieważ przerwanie leczenia przeciwzakrzepowego prowadzić może do ciężkich powikłań zakrzepowo-zatorowych, podjęto próbę wykonania zabiegów chirurgicznych w jamie ustnej bez odstawienia antykoagulantów, opierając się na danych z literatury światowej. Cel: Przedstawienie badań własnych dotyczących leczenia pacjentów z chorobami układu krążenia, przyjmujących pochodne kumaryny i/lub kwasu acetylosalicylowego, bez zmiany schematu leczenia przeciwzakrzepowego proponowanego przez kardiologa. Metody: Grupę badaną stanowiło 40 pacjentów: 12 kobiet i 28 mężczyzn w wieku 39–83 lat (średnia 58 lat), hospitalizowanych w okresie od stycznia 2000 r. do czerwca 2003 r. w I Klinice Chirurgii Szczękowo-Twarzowej w Zabrzu. W pracy przedstawiono wyniki badań własnych dotyczących leczenia pacjentów z chorobami układu krążenia, przyjmujących pochodne kumaryny i/lub kwasu acetylosalicylowego, bez zmiany schematu leczenia. Wyniki: Przeciwzakrzepowa aktywność koagulantów oszacowana na podstawie wskaźnika INR wynosiła w dniu zabiegu od 1,0 do 4,0. Czas kaolinowo-kefalinowy u leczonych pacjentów wynosił od 26 do 88 sekund, przy wartościach referencyjnych od 42 do 65 sekund. Wartości wskaźnika protrombinowego wahały się w przedziale od 26% do 100% przy wartościach referencyjnych od 80% do 120%. Jedynie u 8% chorych wystąpiły niewielkie miejscowe krwawienia, które opanowano zastosowaniem dodatkowej, miejscowej hemostazy. Wnioski: Ekstrakcje zębów oraz inne zabiegi z zakresu chirurgii jamy ustnej mogą być przeprowadzane bez odstawiania antykoagulantów.Introduction: Patients who receive oral anticoagulants generally undergo oral surgery procedures, especially teeth extractions. Because the withdrawal of anticoagulant therapy may lead to severe thromboembolic complications, an attempt to perform oral surgery procedures without discontinuation of anticoagulation, based on the published reports, was made. Aim: To present our own experience with the maintenance of anticoagulant therapy with oral coumarin-type drugs and/or acetylsalicylic acid in patients with cardiovascular diseases who undergo oral surgical procedures. Methods: The group consisted of 40 patients (12 females and 28 males) aged 39-83 years (mean age 58 years) hospitalised in the 1st Department of Oral and Maxillofacial Surgery in Zabrze from January 2000 to June 2003. The following paper presents the results of the treatment of patients with cardiovascular diseases, who are on oral coumarin-type anticoagulants and/or acetylsalicylic acid, performed without modification of the treatment/anticoagulant therapy. Results: The level of anticoagulation defined as the INR (International Normalized Ratio) and measured in all patients on the day of surgery ranged from 1.0 to 4.0. Activated Partial Thromboplastin Time (aPTT) was between 26 and 88 seconds, with a reference range in healthy subjects of 42-65 seconds. The prothrombin time ratio ranged from 26% to 100% (N: 80-120%). Only 8% of patients developed minor bleeding complications which were promptly controlled with additional haemostasis. Conclusions: Teeth extractions and other oral surgical procedures may be performed without discontinuation of anticoagulants

Benefit of Leukocyte- and Platelet-Rich Plasma in Operative Wound Closure in Oral and Maxillofacial Surgery

This article reports the influence of an autologous leukocyte- and platelet-rich plasma (L-PRP) injection as a minimally invasive method on supporting wound healing processes after a mandibular odontogenic cystectomy and double mandibular fracture fixation. 113 patients were enrolled into a control group (received no L-PRP injection) and 102 patients were enrolled into an L-PRP group with an oral mucosa incision. 18 patients after a double mandibular fracture were operated on using 2 external submandibular approaches receiving no fluids in the right site (a control group) and an L-PRP injection in the left incision (L-PRP group). Clinical observations showed that the oral mucosa healed faster in patients treated with L-PRP, in comparison to cases where inductive biomaterial was not added. Pain at the L-PRP injection site was relieved within few hours after an operation in patients with double mandibular fractures. However, there were no differences observed in the progression of the healing process. L-PRP possesses inductive properties that could stimulate healing processes and it seems to be one of the most promising methods in the future for the treatment of soft tissue defects

A new aspect of in vitro antimicrobial leukocyte- and platelet-rich plasma activity based on flow cytometry assessment

The current literature suggests that the antibacterial effect of leukocyte- and platelet-rich plasma (L-PRP) is directly related to platelet and leukocyte concentrations. The aim of this study was twofold: first, to evaluate the antimicrobial effect of L-PRP against selected bacterial strains in vitro, and second, to correlate this effect with leukocyte and platelet content in the final concentration. Blood was collected from 20 healthy males, and L-PRP, acellular plasma (AP), and autologous thrombin were consecutively prepared. Flow cytometry analysis of the blood, L-PRP, and AP was performed. The L-PRP gel, liquid L-PRP, and thrombin samples were tested in vitro for their antibacterial properties against seven selected bacterial strains using the Kirby–Bauer disk-diffusion method. There was notable antimicrobial activity against selected bacterial strains. No statistically significant correlations between antimicrobial activities and the platelet concentration in L-PRP were observed. Statistically significant positive correlations between selected leukocyte subtypes and antimicrobial activity were noted. A negative correlation was found between elevated monocyte count and antimicrobial activity of L-PRP against one bacterial strain studied. L-PRP possesses antimicrobial activity and can be potentially useful in the fight against certain postoperative infections. The bactericidal effect of L-PRP is caused by leukocytes, and there exists a relationship among selected leukocyte subtypes and L-PRP antimicrobial activity

The “biological chamber” method – use of autologous platelet-rich plasma (PRP) in the treatment of poorly healing lower-leg ulcers of venous origin

Wound healing is a complex pathophysiological process, in which platelets play a crucial role. Platelet alpha-granules release growth factors to the wound bed; the factors are necessary in the healing process. In chronic wounds, such as poorly healing lower-leg ulcers of venous origin, there is decreased activity of multiple growth factors, so the concept of exogenous delivery of such factors seems a logical strategy. Platelet-rich plasma therapy in patients with lower-leg ulcers of venous origin combined with conventional treatment methods (previously ineffective in these patients) seems, based on our observation, an important adjunct leading to recovery. The aim of the study was to present an original method of autologous platelet-rich plasma application through the creation of a sort of “biological chamber” containing a concentrate of growth factors. Material and methods. The described therapy was implemented in 10 patients, who had been ineffectively treated for more than one year in the outpatient setting. Patients with exacerbation of inflammatory process, signs of wound infection and ankle brachial pressure index < 0.8 were excluded from the study. After the application of platelet-rich plasma, further treatment was continued with the use of moist therapy and compression therapy according to a uniform regimen. Results. Complete healing was achieved within 4-10 weeks from the beginning of the product administration in all patients. Conclusion. The presented method seems technically simple, effective and relatively inexpensiv

Diversity of influenza-like illness etiology in Polish Armed Forces in influenza epidemic season

The aim of this study was to conduct an epidemiological and laboratory surveillance of Influenza-Like Illnesses (ILI) in Polish Armed Forces, civilian military personnel and their families in 2011/2012 epidemic season, under the United States Department of Defense-Global Emerging Infections Surveillance and Response System (DoD-GEIS). ILI incidence data were analyzed in relation to age, gender, patient category as well as pathogen patterns. Multiple viral, bacterial and viral-bacterial co-infections were identified. Nose and throat swabs of active duty soldiers in the homeland country and in the NATO peacekeeping forces KFOR (Kosovo Force), as well as members of their families were tested for the presence of viral and bacterial pathogens. From October 2011 to May 2012, 416 specimens from ILI symptoms patients were collected and analyzed for the presence of viral and bacterial pathogens. Among viruses, coronavirus was the most commonly detected. In the case of bacterial infections, the most common pathogen was Staphylococcus aureus