Sophie Lejeune

Université de Rennes 1, Roazhon, Brittany, France

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Publications (3)1.85 Total impact

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    ABSTRACT: Avant un acte de chirurgie buccale, trois attitudes cliniques sont possibles face aux patients hypocoagulés par antivitamines K (AVK) : maintenir le traitement, l'arrêter ou réaliser un relais héparinique. Quelques mois après la publication par la Société Francophone de Médecine Buccale et de Chirurgie Buccale (SFMBCB) en accord avec la Société Française de Cardiologie (SFC) de recommandations pour la prise en charge de patients sous AVK en chirurgie buccale, cette étude évalue ces recommandations en terme de rapport coût/sécurité. La simulation des coûts globaux de la prise en charge des patients sous AVK pour l'extraction d'une dent incluse réalisée dans ce travail semble montrer une différence entre les attitudes cliniques publiées dans la littérature. Il semble plus coûteux de traiter des patients à risque hémorragique important que des patients à risque hémorragique plus faible. Intervenir sans modification du traitement, attitude la plus sûre pour le patient, semble également la moins onéreuse. Lors de la réalisation d'un relais aux héparines, le protocole le plus économique est d'utiliser des héparines de bas poids moléculaire administrées par une infirmière à domicile. L'hospitalisation pour un relais avec des héparines non-fractionnées administrées par voie intraveineuse continue chez le patient à risque thrombotique très important semble être l'attitude la plus onéreuse. L'interruption du traitement AVK expose le patient à des risques d'accidents thromboemboliques potentiellement gravissimes ; cette attitude clinique n'est pas la moins coûteuse. Ainsi, le rapport coût/sécurité de « l'absence de modification du traitement » est largement positif tandis que celui de « l'interruption du traitement » est largement négatif. (Med Buccale Chir Buccale 2009 ; 15 : 17-30). Dental surgeons have 3 possibilities before a dental extraction when the patient is hypo coagulated by an AVK: stop the treatment, change it by a heparin therapy or change nothing. Risks for the patient are the risk of embolism and the haemorrhagic risk. This study simulates the different costs and safety of the extraction of an included tooth according to the protocol used for management of the oral anticoagulation treatment. The first option is very dangerous for the patient because of the extremely serious risk of embolism. This option is not cheaper than the others because of the difficulty to balance the INR after the resumption of the treatment. A lot of biological exams are necessary. The second option is expensive because of the biological exams and because of the heparin's injection, at home by a nurse or at hospital. The risk of embolism is also augmented. The last protocol, to choose if it is possible, is very safe for the patient because there is no higher risk of embolism. Furthermore, this option is very inexpensive. So, it seems to be better for the cost and the safety of the patient not to change the anticoagulation treatment. (Med Buccale Chir Buccale 2009 ; 15 : 17-30).
    No preview · Article · Jan 2009
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    ABSTRACT: The aim of this survey was to show that tooth extraction could be performed in patients taking antiplatelet agents. The main indication of antiplatelet agents is to reduce the thrombotic disease. The authors made a descriptive and retrospective analysis of 52 patients taking antiplatelet agents in their department between February 2003 and January 2005. Two hundred and eighteen tooth extractions were performed. For each extraction, a protocol of local hemostasis (filling, suture, compression) was applied. Three hemorrhagic sockets were reported out of 218 extractions performed without stopping the antiplatelet agent treatment (1.3%). One patient presented with persistent bleeding out of 52 cases (1.9%). No hemostasis had been performed on this patient; a local hemostasis was performed during surgical revision, which stopped the persistent bleeding. These results show that the hemorrhagic risk can be controlled by a local hemostasis protocol.
    No preview · Article · Dec 2007 · Revue de Stomatologie et de Chirurgie Maxillo-faciale
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    ABSTRACT: Dental extraction in hemophiliacs is associated with a high risk of bleeding. It requires a multidisciplinary approach and stringent protocol. The current trend is to simplify these protocols. In this study we review the efficacy of a protocol using systemic treatment--factors/dihydro-D-arginine vasopressin (DDAVP)--and simplified local hemostatic measures to control bleeding, to limit patient discomfort, and to minimize hospital length of stay. This retrospective study of 55 dental extractions was performed during 19 interventions in 16 patients with hemophilia A or B to assess the efficacy of a protocol combining general management via the injection of factor concentrates or DDAVP and local hemostasis using biological glue and gelatin packing. Compressive, hemostatic splints, which have been in use by some for many years, are replaced by intermittent tranexamic acid compression during the first 3 days after surgery. We recorded 6 instances of postsurgical bleeding, 4 of which occurred after the compression period. In 2 cases repetition of the local hemostasic measures was required along with the injection of an antihemophilic factor concentrate. In the other 4 cases, the patients' condition reverted to normal following injection of the factor concentrate and the reapplication of the compression. The adopted protocol produced a reliable outcome, limiting the duration of the hospital stay to 24 hours in most cases, and improving postsurgical comfort thanks to a combination of systemic treatment and local hemostasic measures including intermittent tranexamic acid compression.
    No preview · Article · Apr 2005 · Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology