Relação da doença periodontal com a anticoagulação oral e os benefícios do tratamento periodontal em pacientes anticoagulados

• Autor(a) principal: Hottz, érika Menezes de Almeida
• Data de Publicação: 2009
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/14110
• topic: Warfarin; International Normalized Ratio; Periodontitis; Anticoagulants; Heart valve diseases; Thrombosi; Varfarina; Coeficiente internacional normalizado; Periodontite; Anticoagulantes; Doenças das valvas cardíacas; Trombose; Sistema cardiovascular - Doenças; CNPQ::CIENCIAS DA SAUDE::ODONTOLOGIA::PERIODONTIA

Oral anticoagulants are widely indicated to prevent thromboembolic events. However, sometimes patients are not in optimal therapeutic range. The aims of this study were to evaluate the association between periodontitis and anticoagulant therapy (phase 1) and the effect of periodontal treatment on anticoagulant levels (phase 2) in patients using oral anticoagulant warfarin. Clinical examination included DMFT index, visible dental plaque, bleeding on probing, probing pocket depth and clinical attachment loss. International Normalizer Ratio (INR), levels of albumin, C-reactive protein (CRP) and fibrinogen were analyzed at baseline and up to 180 days after periodontal therapy. At phase 1, 62 patients were examined (42 women and 20 men, mean age 50,8 ± 9,2 years). A negative correlation was observed between extension and severity of periodontal disease and visible dental plaque and INR values. There was no association between periodontal diagnosis and anticoagulant levels. Among patients out of the therapeutic range, 87% have periodontitis while in the group on optimal anticoagulant level only 56% have periodontitis. 26 patients with severe periodontitis were enrolled on phase 2 (15 women and 11 men, age mean 51,3 ± 9,2 years). Periodontal treatment resulted in improvement of all periodontal parameters and of the anticoagulant levels 30, 60 90 and 180 days after periodontal therapy. There was no significant change in varfarin weekely dose. On days 90 and 180, there was a significant reduction on sera albumin as compared to day 0 values (p < 0,05). Twelve patients (46,15%) were under therapeutic range at baseline. There was a significant reduction of this frequency after treatment, 26,1% and 29,2% on days 60 and 90, respectively. Although there was no improvent on anticoagulant levels, no significant change on CRP and fibrinogen levels was observed. Severe periodontitis patients may present some difficulty to achieve therapeutic anticoagulant level and periodontal therapy may result in benefits in anticoagulation. Other studies are necessary to evaluate if less severe forms of periodontal disease can also interfere with warfarin.