In patients with liver cirrhosis, the balance between anticoagulant and coagulant factors is compromised, so the hemostasis and coagulation processes are altered and not in perfect balance as they should be.
Hypofunctionality of the liver and oral surgery
Cirrhosis of the liver is a pathology that generates in the patient a hypofunctionality of the liver, a determining organ in the function of coagulation and in the synthesis of thrombopoietin.
In the patient who has a damaged liver, a state of hypocoagulability is determined; many blood values, such as the presence of platelets, prothrombin, the international normalized ratio and the active partial thromboplastin time, are altered.
Cirrhosis of the liver and risk of bleeding
The clinical condition of a patient with cirrhosis could promote the risk of unusual bleeding during an oral surgery treatment, but this is only a hypothesis.
A recent review of the scientific literature has focused precisely on the correlation between the risk of haemorrhage during the surgical phase and in the postoperative period in patients with liver cirrhosis who have undergone oral surgery, in particular the extraction of one or more teeth.
100 clinical cases were analyzed, 7 studies met the inclusion criteria. Sample sizes ranged from 23 to 318 participants, the number of extracted teeth ranged from 62 to 1183, the platelet count ranged from 16,000 to 216,000 per cubic millimeter and the INR was less than 4.
In the results published in JADA of January 2021 it emerged that the prevalence of bleeding events in the studies was found to vary from 0% to 8.9% and almost all were controlled with local haemostatic measures.
Risk assessment
The data therefore show that there is no clear correlation between the risk of haemorrhage and liver cirrhosis during oral surgery treatments. Patients with liver cirrhosis demonstrate a low risk of bleeding despite the reduced number of platelets and the increase in INR.
Thanks to modern dental techniques, which guarantee interventions with a very low risk of bleeding, even patients who have a liver disease can undergo oral surgery in total safety.
