Postoperative bleeding after dentoalveolar surgery in patients with thrombocytopenia-are prophylactic platelet transfusions necessary?

PURPOSE

Benefits of prophylactic platelet (PLT) transfusion before dentoalveolar surgery are unclear. This study investigated the effect of prophylactic PLT transfusions on the incidence of postoperative bleeding (POB) in patients with thrombocytopenia and a PLT count ≤ 75*10/L.

METHODS

The cohort in this retrospective study comprised 83 patients with thrombocytopenia ≤ 75*10/L who had undergone dentoalveolar surgery. Exclusion criteria were other coagulation deficiencies or medications that would affect hemostasis. In all, 144 teeth had been removed. POB events were extracted and compared between the group that had received prophylactic PLT transfusion before dentoalveolar surgery and the group that had not.

RESULTS

POB events were observed in 5 of 83 patients (6.0%) who had a median PLT count of 3510/L before any transfusion. The group with no postoperative bleeding (NPOB) had a median PLT count of 3410/L. Two (4.2%) of the 48 patients who had received prophylactic PLT transfusions before dentoalveolar surgery developed POB. Three (8.6%) of the 35 patients who had not received a transfusion experienced POB. The difference between these two groups was not significant (p = 0.646). When two or more teeth were removed in the same session, a significantly higher incidence of POB was observed (p = 0.042).

CONCLUSIONS

Our data indicate that prophylactic PLT transfusions in thrombocytopenic patients with PLT counts ≤ 75*10/L do not reduce the incidence of POB after dentoalveolar surgery. However, caution is warranted when extracting multiple teeth in the same surgical session since we found this to be significantly associated with an increased risk of POB.