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      Avaliação do nível de conhecimento de cirurgiões-dentistas e graduandos em Odontologia quanto ao manejo de indivíduos em uso de anticoagulantes orais Translated title: Assessment of dentists and dental students’ level of knowledge in the management of individuals using oral anticoagulants

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          Abstract

          Resumo Introdução Diante da alta incidência das doenças cardiovasculares, muitos são os pacientes que fazem uso de medicações para prevenção e tratamento dessas desordens. Consequentemente, o número de pessoas em uso de anticoagulantes orais a serem submetidas a tratamento odontológico é crescente e o manejo desses indivíduos requer criteriosa avaliação da condição clínica e do procedimento a ser realizado. Objetivo Avaliar o nível de conhecimento de cirurgiões-dentistas e graduandos em Odontologia quanto ao manejo de indivíduos em uso de anticoagulantes orais a serem submetidos a tratamento odontológico. Material e método Investigação descritiva, quantitativa, de corte transversal, com base em um questionário respondido por 100 indivíduos, sendo 70 cirurgiões-dentistas e 30 graduandos do curso de Odontologia, escolhidos por conveniência, para avaliar o conhecimento sobre o tema proposto. Para comparação das variáveis quantitativas, foi utilizado o Teste t de student, para comparação de duas amostras, e o Teste ANOVA, com pós-teste de Bonferroni, para comparação de três amostras. Resultado Dentre os entrevistados, 74,5% dos cirurgiões-dentistas e 54,2% dos graduandos relataram já ter atendido um paciente que faz uso de anticoagulante oral. Não houve diferença estatística quanto ao desempenho entre profissionais e alunos acerca do manejo odontológico de pacientes em uso de anticoagulantes. Dentre o grupo de cirurgiões-dentistas, os profissionais da cirurgia bucomaxilofacial e os que fizeram residência multiprofissional apresentaram melhor desempenho quando comparados aos clínicos gerais. Conclusão Pôde-se concluir que, para os grupos estudados, o manejo de pessoas em uso de anticoagulantes orais ainda é um desafio.

          Translated abstract

          Abstract Introduction Cardiovascular diseases have a high incidence and due to that there is a large amount of patients who take medications for prevention and treatment of these disorders. Consequently, the number of people to be submitted to dental treatment and also under oral anticoagulant therapy is increasing and the management of these individuals requires a careful evaluation of the clinical condition and the procedure to be performed. Objective To evaluate the level of knowledge of dentists and undergraduate dental students in the management of individuals using oral anticoagulants to be submitted to dental treatment. Material and method Descriptive, quantitative, cross-sectional study based on a questionnaire answered by 100 individuals (70 dentists and 30 undergraduate dental students), chosen for convenience to evaluate their knowledge about the proposed topic. To compare the quantitative variables, the Student's T test was used to compare two samples and the ANOVA test with Bonferroni's post test to compare three samples. Result Among the interviewees, 74.5% of dental surgeons and 54.2% of undergraduates reported having attended a patient under oral anticoagulant therapy. There was no statistical difference regarding the performance between professionals and students in the dental management of patients taking anticoagulants. Among the group of dental surgeons, the professionals of the bucomaxillofacial surgery and those who had multiprofessional residency presented better performance when compared to the general practitioners. Conclusion The management of patients using oral anticoagulants stills a challenge for the groups studied.

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          New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events

          Despite the discovery and application of many parenteral (unfractionated and low-molecular-weight heparins) and oral anticoagulant vitamin K antagonist (VKA) drugs, the prevention and treatment of venous and arterial thrombotic phenomena remain major medical challenges. Furthermore, VKAs are the only oral anticoagulants used during the past 60 years. The main objective of this study is to present recent data on non-vitamin K antagonist oral anticoagulants (NOACs) and to analyze their advantages and disadvantages compared with those of VKAs based on a large number of recent studies. NOACs are novel direct-acting medications that are selective for one specific coagulation factor, either thrombin (IIa) or activated factor X (Xa). Several NOACs, such as dabigatran (a direct inhibitor of FIIa) and rivaroxaban, apixaban and edoxaban (direct inhibitors of factor Xa), have been used for at least 5 years but possibly 10 years. Unlike traditional VKAs, which prevent the coagulation process by suppressing the synthesis of vitamin K-dependent factors, NOACs directly inhibit key proteases (factors IIa and Xa). The important indications of these drugs are the prevention and treatment of deep vein thrombosis and pulmonary embolisms, and the prevention of atherothrombotic events in the heart and brain of patients with acute coronary syndrome and atrial fibrillation. They are not fixed, and dose-various strengths are available. Most studies have reported that more advantages than disadvantages for NOACs when compared with VKAs, with the most important advantages of NOACs including safety issues (ie, a lower incidence of major bleeding), convenience of use, minor drug and food interactions, a wide therapeutic window, and no need for laboratory monitoring. Nonetheless, there are some conditions for which VKAs remain the drug of choice. Based on the available data, we can conclude that NOACs have greater advantages and fewer disadvantages compared with VKAs. New studies are required to further assess the efficacy of NOACs.
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            Trends in Mortality Rate from Cardiovascular Disease in Brazil, 1980-2012

            Background Studies have questioned the downward trend in mortality from cardiovascular diseases (CVD) in Brazil in recent years. Objective to analyze recent trends in mortality from ischemic heart disease (IHD) and stroke in the Brazilian population. Methods Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. Risk of death was adjusted by the direct method, using as reference the world population of 2000. We analyzed trends in mortality from CVD, IHD and stroke in women and men in the periods of 1980-2006 and 2007-2012. Results there was a decrease in CVD mortality and stroke in women and men for both periods (p < 0.001). Annual mortality variations for periods 1980-2006 and 2007-2012 were, respectively: CVD (total): -1.5% and -0.8%; CVD men: -1.4% and -0.6%; CVD women: -1.7% and -1.0%; DIC (men): -1.1% and 0.1%; stroke (men): -1.7% and -1.4%; DIC (women): -1.5% and 0.4%; stroke (women): -2.0% and -1.9%. From 1980 to 2006, there was a decrease in IHD mortality in men and women (p < 0.001), but from 2007 to 2012, changes in IHD mortality were not significant in men [y = 151 + 0.04 (R2 = 0.02; p = 0.779)] and women [y = 88-0.54 (R2 = 0.24; p = 0.320). Conclusion Trend in mortality from IHD stopped falling in Brazil from 2007 to 2012.
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              Anticoagulation and minor oral surgery: should the anticoagulation regimen be altered?

              This study was performed to assess the extent of bleeding in anticoagulated patients undergoing minor oral surgery procedures when compared with patients who stop their anticoagulation regimen before surgery and patients who have never been anticoagulated.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rounesp
                Revista de Odontologia da UNESP
                Rev. odontol. UNESP
                Universidade Estadual Paulista Júlio de Mesquita Filho (Araraquara, SP, Brazil )
                0101-1774
                1807-2577
                October 2018
                : 47
                : 5
                : 321-327
                Affiliations
                [01] Aracaju Sergipe orgnameUniversidade Federal de Sergipe Brazil
                Article
                S1807-25772018000500321
                10.1590/1807-2577.09718
                73f9f7b5-95de-4b7c-bb78-bbe17570e419

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 26 September 2018
                : 19 October 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 7
                Product

                SciELO Brazil


                odontologia,Anticoagulants,platelet aggregation inhibitors,dentistry,Anticoagulantes,inibidores da agregação de plaquetas

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