O risco de sangramento durante a extra\u00e7\u00e3o dent\u00e1ria \u00e9 pequeno, enquanto o risco de trombose, caso o tratamento seja interrompido incorretamente, pode ser catastr\u00f3fico.<\/h2>\n\n\n\n![\"\u043a\u0430\u0440\u0438\u0435\u0441](\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\")
<\/a>O risco de sangramento durante a extra\u00e7\u00e3o dent\u00e1ria pode ser facilmente controlado.<\/figcaption><\/figure>\n\n\n\nO principal problema \u00e9 que o risco de sangramento durante a extra\u00e7\u00e3o dent\u00e1ria geralmente \u00e9 control\u00e1vel, enquanto o risco de trombose, caso a terapia seja interrompida incorretamente, pode ser catastr\u00f3fico. A Associa\u00e7\u00e3o Americana de Odontologia afirma que, na maioria dos pacientes, n\u00e3o \u00e9 necess\u00e1rio alterar a terapia anticoagulante ou antiplaquet\u00e1ria antes da interven\u00e7\u00e3o odontol\u00f3gica, e o sangramento geralmente \u00e9 controlado com medidas locais.<\/p>\n\n\n\n
Este \u00e9 exatamente um dos pontos principais da posi\u00e7\u00e3o do Dr. Nosikov: a suspens\u00e3o desses medicamentos n\u00e3o \u00e9 inofensiva. Em um paciente com stent, por exemplo, a suspens\u00e3o de um antiplaquet\u00e1rio pode levar \u00e0 trombose do stent \u2013 um bloqueio agudo e potencialmente fatal de um vaso coron\u00e1rio. Em um paciente com fibrila\u00e7\u00e3o atrial, a suspens\u00e3o inadequada de um anticoagulante pode aumentar o risco de acidente vascular cerebral emb\u00f3lico. As consequ\u00eancias podem ser morte ou incapacidade permanente.<\/p>\n\n\n\n
Cobertura tempor\u00e1ria com heparina \u2014 n\u00e3o \u00e9 uma pr\u00e1tica padr\u00e3o para todos os pacientes.<\/h2>\n\n\n\n
\u00c9 importante esclarecer que as heparinas de baixo peso molecular, conhecidas pelos pacientes por nomes comerciais como Clexane ou Fraxiparina, n\u00e3o s\u00e3o um "substituto" universal. Elas n\u00e3o substituem os antiplaquet\u00e1rios. E com os anticoagulantes orais diretos, a chamada terapia de transi\u00e7\u00e3o \u2014 uma "cobertura" tempor\u00e1ria \u2014 com heparina <\/a><\/strong>\u2014 n\u00e3o \u00e9 uma pr\u00e1tica padr\u00e3o para todos os pacientes. O Col\u00e9gio Americano de Cardiologia tamb\u00e9m enfatiza que, em pacientes em uso de anticoagulantes orais diretos, geralmente n\u00e3o h\u00e1 indica\u00e7\u00e3o para terapia de transi\u00e7\u00e3o com heparina ou heparina de baixo peso molecular, pois o per\u00edodo sem anticoagula\u00e7\u00e3o, quando necess\u00e1rio, \u00e9 curto.<\/p>\n\n\n\nEm procedimentos odontol\u00f3gicos, a decis\u00e3o depende de muitos fatores: quais medicamentos o paciente est\u00e1 tomando, por que os est\u00e1 tomando, quando o stent foi colocado, se ele tem fibrila\u00e7\u00e3o atrial, hist\u00f3rico de acidente vascular cerebral, doen\u00e7a renal, alto risco de sangramento, que tipo de extra\u00e7\u00e3o ser\u00e1 realizada e qual anestesia ser\u00e1 utilizada. Portanto, n\u00e3o existe um protocolo \u00fanico e seguro que se aplique a todos.<\/p>\n\n\n\n
As diretrizes atuais consideram a maioria dos procedimentos odontol\u00f3gicos menores como interven\u00e7\u00f5es de baixo risco. Uma revis\u00e3o de 2024 observou que, para a maioria desses procedimentos, a terapia antiplaquet\u00e1ria ou anticoagulante pode ser continuada sem interrup\u00e7\u00e3o, e medidas hemost\u00e1ticas locais \u2014 como press\u00e3o, suturas, agentes hemost\u00e1ticos t\u00f3picos ou enxaguante bucal com \u00e1cido tranex\u00e2mico \u2014 s\u00e3o utilizadas conforme a necessidade.<\/p>\n\n\n\n
Alguns pacientes podem precisar pular uma dose ou adiar a administra\u00e7\u00e3o de uma dose.<\/h2>\n\n\n\n<\/a><\/figure>\n\n\n\nIsso n\u00e3o significa que uma mudan\u00e7a na terapia nunca seja feita. Em alguns pacientes e para procedimentos de maior risco, pode ser necess\u00e1rio pular uma dose, atrasar uma dose ou fazer uma pausa mais longa. Mas isso deve ser avaliado previamente por um m\u00e9dico que conhe\u00e7a o risco cardiovascular do paciente. As diretrizes do SDCEP tamb\u00e9m enfatizam a necessidade de uma avalia\u00e7\u00e3o espec\u00edfica de acordo com o medicamento, o procedimento e o risco de sangramento.<\/p>\n\n\n\n
A recomenda\u00e7\u00e3o pr\u00e1tica para os pacientes \u00e9 clara: n\u00e3o interrompa o uso de anticoagulantes ou antiplaquet\u00e1rios por conta pr\u00f3pria antes da extra\u00e7\u00e3o dent\u00e1ria. Se o dentista ou cirurgi\u00e3o acreditar que existe risco de sangramento, deve solicitar uma consulta pr\u00e9-operat\u00f3ria com um cardiologista, na qual o procedimento, o risco esperado de sangramento e o tipo de anestesia devem ser descritos. Somente ent\u00e3o o cardiologista poder\u00e1 fornecer uma recomenda\u00e7\u00e3o por escrito sobre se a terapia deve ser continuada, alterada temporariamente ou se o procedimento deve ser adiado.<\/p>\n\n\n\n
A extra\u00e7\u00e3o dent\u00e1ria geralmente n\u00e3o \u00e9 uma interven\u00e7\u00e3o de emerg\u00eancia. Portanto, a abordagem mais segura \u00e9 tomar a decis\u00e3o em tempo oportuno \u2014 n\u00e3o no dia do procedimento e n\u00e3o por meio de uma mensagem r\u00e1pida, mas ap\u00f3s uma avalia\u00e7\u00e3o m\u00e9dica completa.<\/p>\n\n\n\n
Editora Ina Dimitrova<\/p>","protected":false},"excerpt":{"rendered":"
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![\"\u043a\u0430\u0440\u0438\u0435\u0441](\"https:\/\/bolenzdrav.com\/wp-content\/uploads\/2015\/12\/zahn_9.jpg\")
<\/a>O principal problema \u00e9 que o risco de sangramento durante a extra\u00e7\u00e3o dent\u00e1ria geralmente \u00e9 control\u00e1vel, enquanto o risco de trombose, caso a terapia seja interrompida incorretamente, pode ser catastr\u00f3fico. A Associa\u00e7\u00e3o Americana de Odontologia afirma que, na maioria dos pacientes, n\u00e3o \u00e9 necess\u00e1rio alterar a terapia anticoagulante ou antiplaquet\u00e1ria antes da interven\u00e7\u00e3o odontol\u00f3gica, e o sangramento geralmente \u00e9 controlado com medidas locais.<\/p>\n\n\n\n
Este \u00e9 exatamente um dos pontos principais da posi\u00e7\u00e3o do Dr. Nosikov: a suspens\u00e3o desses medicamentos n\u00e3o \u00e9 inofensiva. Em um paciente com stent, por exemplo, a suspens\u00e3o de um antiplaquet\u00e1rio pode levar \u00e0 trombose do stent \u2013 um bloqueio agudo e potencialmente fatal de um vaso coron\u00e1rio. Em um paciente com fibrila\u00e7\u00e3o atrial, a suspens\u00e3o inadequada de um anticoagulante pode aumentar o risco de acidente vascular cerebral emb\u00f3lico. As consequ\u00eancias podem ser morte ou incapacidade permanente.<\/p>\n\n\n\n
Cobertura tempor\u00e1ria com heparina \u2014 n\u00e3o \u00e9 uma pr\u00e1tica padr\u00e3o para todos os pacientes.<\/h2>\n\n\n\n
\u00c9 importante esclarecer que as heparinas de baixo peso molecular, conhecidas pelos pacientes por nomes comerciais como Clexane ou Fraxiparina, n\u00e3o s\u00e3o um "substituto" universal. Elas n\u00e3o substituem os antiplaquet\u00e1rios. E com os anticoagulantes orais diretos, a chamada terapia de transi\u00e7\u00e3o \u2014 uma "cobertura" tempor\u00e1ria \u2014 com heparina <\/a><\/strong>\u2014 n\u00e3o \u00e9 uma pr\u00e1tica padr\u00e3o para todos os pacientes. O Col\u00e9gio Americano de Cardiologia tamb\u00e9m enfatiza que, em pacientes em uso de anticoagulantes orais diretos, geralmente n\u00e3o h\u00e1 indica\u00e7\u00e3o para terapia de transi\u00e7\u00e3o com heparina ou heparina de baixo peso molecular, pois o per\u00edodo sem anticoagula\u00e7\u00e3o, quando necess\u00e1rio, \u00e9 curto.<\/p>\n\n\n\n Em procedimentos odontol\u00f3gicos, a decis\u00e3o depende de muitos fatores: quais medicamentos o paciente est\u00e1 tomando, por que os est\u00e1 tomando, quando o stent foi colocado, se ele tem fibrila\u00e7\u00e3o atrial, hist\u00f3rico de acidente vascular cerebral, doen\u00e7a renal, alto risco de sangramento, que tipo de extra\u00e7\u00e3o ser\u00e1 realizada e qual anestesia ser\u00e1 utilizada. Portanto, n\u00e3o existe um protocolo \u00fanico e seguro que se aplique a todos.<\/p>\n\n\n\n As diretrizes atuais consideram a maioria dos procedimentos odontol\u00f3gicos menores como interven\u00e7\u00f5es de baixo risco. Uma revis\u00e3o de 2024 observou que, para a maioria desses procedimentos, a terapia antiplaquet\u00e1ria ou anticoagulante pode ser continuada sem interrup\u00e7\u00e3o, e medidas hemost\u00e1ticas locais \u2014 como press\u00e3o, suturas, agentes hemost\u00e1ticos t\u00f3picos ou enxaguante bucal com \u00e1cido tranex\u00e2mico \u2014 s\u00e3o utilizadas conforme a necessidade.<\/p>\n\n\n\n Isso n\u00e3o significa que uma mudan\u00e7a na terapia nunca seja feita. Em alguns pacientes e para procedimentos de maior risco, pode ser necess\u00e1rio pular uma dose, atrasar uma dose ou fazer uma pausa mais longa. Mas isso deve ser avaliado previamente por um m\u00e9dico que conhe\u00e7a o risco cardiovascular do paciente. As diretrizes do SDCEP tamb\u00e9m enfatizam a necessidade de uma avalia\u00e7\u00e3o espec\u00edfica de acordo com o medicamento, o procedimento e o risco de sangramento.<\/p>\n\n\n\n A recomenda\u00e7\u00e3o pr\u00e1tica para os pacientes \u00e9 clara: n\u00e3o interrompa o uso de anticoagulantes ou antiplaquet\u00e1rios por conta pr\u00f3pria antes da extra\u00e7\u00e3o dent\u00e1ria. Se o dentista ou cirurgi\u00e3o acreditar que existe risco de sangramento, deve solicitar uma consulta pr\u00e9-operat\u00f3ria com um cardiologista, na qual o procedimento, o risco esperado de sangramento e o tipo de anestesia devem ser descritos. Somente ent\u00e3o o cardiologista poder\u00e1 fornecer uma recomenda\u00e7\u00e3o por escrito sobre se a terapia deve ser continuada, alterada temporariamente ou se o procedimento deve ser adiado.<\/p>\n\n\n\n A extra\u00e7\u00e3o dent\u00e1ria geralmente n\u00e3o \u00e9 uma interven\u00e7\u00e3o de emerg\u00eancia. Portanto, a abordagem mais segura \u00e9 tomar a decis\u00e3o em tempo oportuno \u2014 n\u00e3o no dia do procedimento e n\u00e3o por meio de uma mensagem r\u00e1pida, mas ap\u00f3s uma avalia\u00e7\u00e3o m\u00e9dica completa.<\/p>\n\n\n\n Editora Ina Dimitrova<\/p>","protected":false},"excerpt":{"rendered":" \u041f\u0440\u0435\u043a\u044a\u0441\u0432\u0430\u043d\u0435\u0442\u043e \u043d\u0430 \u0430\u043d\u0442\u0438\u043a\u043e\u0430\u0433\u0443\u043b\u0430\u043d\u0442 \u0438\u043b\u0438 \u0430\u043d\u0442\u0438\u0430\u0433\u0440\u0435\u0433\u0430\u043d\u0442 \u043f\u0440\u0435\u0434\u0438 \u0437\u044a\u0431\u043d\u0430 \u0435\u043a\u0441\u0442\u0440\u0430\u043a\u0446\u0438\u044f \u0435 \u043d\u0435 \u0441\u0430\u043c\u043e \u0438\u0437\u043b\u0438\u0448\u043d\u043e, \u043d\u043e \u0438 \u043c\u043d\u043e\u0433\u043e \u0440\u0438\u0441\u043a\u043e\u0432\u0430\u043d\u043e. \u0421 \u0442\u043e\u0437\u0438 \u043f\u0440\u0438\u0437\u0438\u0432 \u0441\u0435 \u043e\u0431\u044a\u0440\u043d\u0430 \u043a\u044a\u043c \u043b\u0435\u043a\u0430\u0440\u0438 \u0438 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0438 \u043a\u0430\u0440\u0434\u0438\u043e\u043b\u043e\u0433\u044a\u0442 \u0434-\u0440 \u0410\u043b\u0435\u043a\u0441\u0430\u043d\u0434\u044a\u0440 \u041d\u043e\u0441\u0438\u043a\u043e\u0432 \u043e\u0442 \u043f\u0440\u043e\u0444\u0438\u043b\u0430 \u0441\u0438 \u0432\u044a\u0432 \u0444\u0435\u0439\u0441\u0431\u0443\u043a. \u041f\u043e\u0432\u043e\u0434 \u0437\u0430 \u043f\u043e\u0437\u0438\u0446\u0438\u044f\u0442\u0430 \u043c\u0443 \u0441\u0430 \u0437\u0430\u0447\u0435\u0441\u0442\u0438\u043b\u0438 \u0438\u0441\u043a\u0430\u043d\u0438\u044f \u0437\u0430 \u043a\u043e\u043d\u0441\u0443\u043b\u0442\u0430\u0446\u0438\u0438 \u0434\u0430\u043b\u0438 \u043f\u043e\u0434\u043e\u0431\u043d\u0438 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430 \u0442\u0440\u044f\u0431\u0432\u0430 \u0434\u0430 \u0431\u044a\u0434\u0430\u0442 \u0441\u043f\u0440\u0435\u043d\u0438 \u043f\u0440\u0435\u0434\u0438 \u0432\u0430\u0434\u0435\u043d\u0435 \u043d\u0430 \u0437\u044a\u0431. \u0421\u0442\u0430\u0432\u0430 […]<\/p>\n","protected":false},"author":3,"featured_media":30198,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5235],"tags":[453,4990,5131],"class_list":{"0":"post-31333","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-zdrave","8":"tag-antikoagulanti","9":"tag-vadene-na-zab","10":"tag-klopidogrel"},"yoast_head":"\nAlguns pacientes podem precisar pular uma dose ou adiar a administra\u00e7\u00e3o de uma dose.<\/h2>\n\n\n\n
![\"\u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430](\"https:\/\/bolenzdrav.com\/wp-content\/uploads\/2019\/03\/lekarstva_hapche25a.jpg\")
<\/a><\/figure>\n\n\n\n