Oral Bleeding Research Articles

Intermittent Oral Hemorrhage in Systemic Sclerosis.

Intermittent Oral Hemorrhage in Systemic Sclerosis.

Association Between Direct Oral Anticoagulant Score and Bleeding Events in Patients With Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Cohort Study.

The Direct Oral Anticoagulant (DOAC) Score can predict bleeding risk in patients with atrial fibrillation taking DOACs; however, it lacks external validation. Therefore, this study aimed to assess the association between the DOAC Score and bleeding events in patients with atrial fibrillation who underwent transcatheter aortic valve replacement. This retrospective multicenter cohort study included patients with atrial fibrillation who underwent transcatheter aortic valve replacement, as registered in a Japanese multicenter registry. The primary end point was the incidence of bleeding. Patients were categorized based on their DOAC Score: low and moderate- (≤7 points), high- (8-9 points), and very high-risk (≥10 points) groups. Among 1230 patients (mean age 84.6±5.1 years; 457 men), 465 (37.8%) received a vitamin K antagonist, and the remaining patients received DOACs. The low and moderate-, high-, and very high-risk groups included 380 (30.1%), 497 (40.4%), and 353 patients (28.7%), respectively. The 3-year cumulative incidence of all bleeding events was significantly different among the 3 groups (low and moderate risk: 6.6%, high risk: 6.9%, and very high risk: 14.0%; P<0.01). Multivariable Cox regression analysis revealed that significant increments in the DOAC Score were associated with a risk of all bleeding events at 3 years in the overall cohort (hazard ratio [HR], 1.22 [95% CI, 1.08-1.38]; P<0.01), in the DOAC cohort (HR, 1.20 [95% CI, 1.01-1.42]; P=0.04), and in the vitamin K antagonist cohort (HR, 1.25 [95% CI, 1.04-1.50]; P=0.02). The DOAC Score was significantly associated with bleeding events in patients with atrial fibrillation after transcatheter aortic valve replacement, aiding in clinical decision-making for anticoagulant management. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023585; Unique identifier: UMIN000020423.

3-Factor prothrombin complex concentrate versus 4-factor prothrombin complex concentrate for the reversal of oral factor Xa inhibitors.

Multiple agents exist for the reversal of oral Factor Xa inhibitor (FXa) associated bleeding, including Coagulation FXa Recombinant, Inactivated zhzo (andexanet alfa) and 4-factor prothrombin complex concentrate (4F-PCC). While classified as a 3F-PCC product, Profilnine contains up to 35IU of Factor VII (per 100IU of Factor IX) in addition to therapeutic levels of Factors II, IX, and X, and has demonstrated a similar impact on prothrombin time and blood product usage in non-warfarin related bleeding. This was a retrospective, multicenter study at four medical centers of adult patients who presented with major bleeding associated with oral FXa inhibitors and received either 4F-PCC (n = 64) or 3F-PCC (n = 61). The primary outcome was hemostatic effectiveness. Secondary outcomes included the incidence of thromboembolism, in-hospital mortality, and length of stay. The most common indication for reversal was intracranial bleeding. For the primary outcome, 84% of all patients were rated as effective with no difference noted between the groups (p = 0.81). No significant difference between groups was found in the multivariable analysis adjusting for baseline differences between groups including race, total body weight, type of bleeding, and the use of antiplatelet therapy. There was no difference in the length of stay, in-hospital mortality, or the incidence of thromboembolism between the groups. Overall, no significant differences were found in the effectiveness or safety of 4F-PCC and 3F-PCC use in the management of oral FXa inhibitor-associated bleeding. Further investigations are warranted to explore the use of 3F-PCC for this indication and its safety and effectiveness.

Extensively harvested hay contaminated with common windgrass induced an ulcerative stomatitis–gingivitis outbreak in horses

SummaryAfter starting feeding on a new batch of hay, 29 out of 33 horses showed clinical signs of oral ulcerative and bleeding papules and mucous membrane erythema of the gingiva of the mandible within 2–3 days. The results of the complete blood cell count and biochemistry analysis did not yield significant findings in relation to horses affected by ulcerative stomatitis. Swab analyses of the oral mucosa for vesicular stomatitis virus (VS, Type Indiana and Type New Jersey) were negative in all horses (n = 33). Common windgrass with long awns in the deeper stomal‐gingival ulcerations was confirmed through botanical analysis by botanical identification. The hay batch fed to the affected horses was assessed via botanical analysis, finding 15% common windgrass (Apera spica‐venti). After the removal of the contaminated hay batch, full recovery was seen in all horses within 2–6 weeks depending on the severity of the lesions. The grassland from which the hay was harvested belonged to a semi‐natural landscape restored to increase biodiversity and as a protection zone in case of overflow of the river Rhine. In conclusion, feeding forages harvested from these semi‐natural landscapes may be harmful to the health of horses.

Pseudoaneurysm of the Lingual Artery in a Patient With Facial Trauma From Gunshot Wounds

A pseudoaneurysm is an abnormal dilatation within the wall of a blood vessel due to the formation of a hematoma in the vessel wall after vessel injury. Because of the protective nature of the facial skeleton and the deep location of the lingual artery, the lingual artery pseudoaneurysm is rare. The authors report a case of a 20-year-old male who suffered multiple gunshot wounds, including to the mouth, presenting with immediate life-threatening injuries. On hospital day 1, otolaryngology performed debridement of the mandible, retrieval and removal of bullet fragments, intermaxillary fixation, external fixation of the mandible, intra-oral laceration repair, repair of tongue laceration, and tracheotomy revision. On postoperative day 15, the otolaryngology service was called for the abrupt onset of major oral cavity bleeding. computed tomography-angiogram detected a pseudoaneurysm of the lingual artery and was successfully treated with endovascular coil embolization.

Emergency of oral haemorrhage: Retrospective study over 2 years.

Oral haemorrhages (OH) represent a relatively rare reason for an emergency consultation, among dental pain, infectious processes and traumas. Various haemorrhagic risk factors are described, particularly those related to a general medical context or local factors. It is common to associate OH with haemorrhagic risk patients. Current studies mainly focus on patients considered at risk, but there is limited data on the characteristics of OH in patients without known haemorrhagic risk. We conducted a 2-year retrospective study in a dental emergency department to identify OH occurring in patients without known haemorrhagic risk and to study their characteristics. OH accounted for approximately 2% of the reasons for consultation among all consultations carried out for dental emergencies. Their frequency was similar in the population of patients without hemorrhagic risk and those with a confirmed risk. They mainly occurred in young patients, without medical history. They also led to the diagnosis of an underlying pathology in about 1% of cases. This study underscores the importance of accurately documenting patients' medical history during preoperative consultations, as well as identifying associated risk factors. It also highlights that OH can be an early sign of a systemic disorder.

Direct Oral Anticoagulants and Bleeding Management Following Tooth Extractions-A Prospective Cohort Study.

The aim of the present study was to assess the occurrence of intra-, peri-, and post-operative bleeding following tooth extractions in patients treated with direct oral anticoagulants (DOACs). Consecutive patients requiring at least one dental extraction were enrolled. The DOAC regimen was either maintained or suspended. Patients were classified in subgroups depending on the number of teeth extracted per procedure (≤3 or >3), the need for flap elevation, and the performance of osteotomy. Bleeding was recorded intra-operatively; peri-operatively at 20, 40, 60, and 80 min after the procedure; and daily in the first seven days following tooth extractions. Forty-nine patients treated with DOACs (17 with rivaroxaban, 16 with apixaban, 8 with edoxaban, and 8 with dabigatran) were enrolled. Of them, 33 refrained from DOAC administration pre-operatively. The performances of >3 teeth extractions, flap elevation, and osteotomy were significantly associated with higher bleeding rates (p < 0.05). In patients treated with rivaroxaban and apixaban, bleeding episodes were more frequent. Although DOAC treatment may increase the rates of intra-operative, peri-operative, and post-operative bleeding, the recorded episodes were mild and manageable. DOAC suspension may reduce peri-operative bleeding, while no effect could be observed for post-operative bleeding.

Long-Term Safety of a Four-Factor Prothrombin Complex Concentrate (Kcentra®/Beriplex® P/N): An Updated Pharmacovigilance Review.

Four-factor prothrombin complex concentrate (4F-PCC) is recommended for vitamin K antagonist reversal in patients with major bleeding or in need of surgery. The most important risk associated with the use of 4F-PCC is the occurrence of thromboembolic events (TEEs). In this review, we aim to evaluate the safety profile of a 4F-PCC (Kcentra®/Beriplex® P/N; CSL Behring, Marburg, Germany) by reviewing pharmacovigilance data. A retrospective analysis of postmarketing pharmacovigilance data of Kcentra®/Beriplex® P/N from February 1996 to April 2022 was performed and complemented by a review of clinical studies published between January 2012 and April 2022. A total of 2,321,443 standard infusions of Kcentra®/Beriplex® P/N were administered during the evaluation period. Adverse drug reactions (ADRs) were reported in 614 cases (∼1 per 3,781 standard infusions) and 233 of these cases (37.9%) experienced suspected TEEs related to 4F-PCC (∼1 per 9,963 standard infusions); most of these cases had pre-existing or concomitant conditions likely to be significant risk factors for thrombosis. TEE rates were similar when 4F-PCC was used on-label or off-label for direct oral anticoagulant-associated bleeding. Thirty-six cases (5.9%) reported hypersensitivity type reactions (∼1 per 64,485 standard infusions). No confirmed case of viral transmission related to 4F-PCC use was reported. The published literature also revealed a favorable safety profile of 4F-PCC. Analysis of postmarketing pharmacovigilance safety reports demonstrated that treatment with 4F-PCC was associated with few ADRs and a low rate of TEEs across multiple indications and settings, thus confirming a positive safety profile of 4F-PCC.

Oral health management in children with severe congenital neutropenia with periodontitis: Case report.

Severe congenital neutropenia (SCN) is a rare and heterogeneous genetic disease. By describing the diagnosis and treatment of a child with SCN and periodontitis, this case provides a reference for the oral health management of a child with SCN and periodontitis. We describe a boy with clinical manifestations of oral bleeding, neutropenia, recurrent fever, and other recurrent infections. The absolute neutrophil count (ANC) was <0.50 × 109/L most of the time. Morphological examination of bone marrow cells showed active granulocyte hyperplasia and dysmaturation. According to the clinical manifestations, hematological examination and gene detection results, the child was diagnosed as SCN with chronic periodontitis. Periodontal treatment was performed after informed consent was obtained from the child guardian. These included supragingival and subgingival cleaning, hydrogen peroxide and saline irrigation, placement of iodoglycerin in the gingival sulcus, and oral hygiene instruction. Hematopoietic stem cell transplantation (HSCT) was performed later. One month after initial periodontal treatment, oral hygiene was well maintained and gingival swelling had subsided. Probing depth (PD) index on periodontal probing and bleeding was significantly reduced. However, there was no significant change in blood routine and other indicators before and after periodontal treatment. Once SCN is diagnosed, individualized treatment plans can be developed according to the characteristics of the disease and its impact on oral health, which can effectively control the interaction between SCN and periodontal disease and reduce the occurrence of serious infection.

Epidemiological, Demographic, and Clinical Characteristics of Von Willebrand Disease Patients in Zahedan City, Iran: A Descriptive Study.

Background:Von Willebrand disease (VWD) is one of the most common coagulative diseases, so identifying the effective factors in preventing this complication is essential. The study aimed to evaluate the frequency of demographic and epidemiological findings in VWD patients referred to a hospital in Zahedan, Iran. Materials and Methods: This study was performed on 76 patients with VWD referred to Hazrat Ali-Asghar Hospital in Zahedan City, Sistan, and Baluchestan province. After obtaining consent from the patients, the demographic information and clinical symptoms of the disease were recorded. All statistical analyses were performed using SPSS 22.0 software. All descriptive data were expressed as mean ±SD and percent (%) depending on the continuous and dichotomous variables. A P-value ≤0.05 was considered significant statistically. Results:The present study results showed that the highest age group of VWD patients at the time of disease diagnosis was in the age group 1-5 years (47.3%), and most patients had type III VWD (80.3%). It was also found that 67.1% of patients had a positive family history and their parents' consanguineous marriage (77.6%). The most common complaints were epistaxis (88.15%), cutaneous bleeding (78.94%), and oral cavity bleeding (61.84%), respectively. Conclusion: Due to the high prevalence of VWD in consanguineous marriages and an increase in adverse complications and symptoms in VWD patients, proper diagnosis and screening at an early age, especially in people with family history, is essential. Efforts are needed to develop national registries and widely provide the required and available basic services for diagnosis and treatment.

Dental management of Fanconi anemia: a rare congenital disorder

PurposeFanconi anemia is a rare inherited genetic disorder that is characterized by all three defective blood cell lines such as reduced red blood cells, platelets, and white blood cells. This makes the individual susceptible to spontaneous oral bleeding and prone to oral infections including periodontal diseases.MethodDental management of individuals with Fanconi anemia can be a difficult task as these individuals have a tendency for uncontrolled hemorrhage and infections after any simple dental procedure. This case report highlights the oral manifestations and management of the same in such individuals taking into consideration the complications in such rare diseases.ResultIn this case report, the individuals’ oral manifestations and spontaneous oral bleeding were successfully managed by preventive single-donor platelet transfusion, factor VII transfusion, and local tranexamic acid usage during the dental interventions along with parental counseling.ConclusionFanconi anemia being a rare inherited disorder is often difficult to manage due to a lack of knowledge and awareness among the dental clinicians. This case report attempts in highlighting the same and spreading awareness among the clinicians.

Evaluation of Child Oral Health Related Quality of Life in Bleeding Disorders

Abstract Background Oral bleeding is a common symptom for many inherited and acquired bleeding disorders in children. Understanding oral health and treatment needs of patients with bleeding disorders is necessary for patients' primary oral health prevention. Aim of the Work To evaluate the oral health problems in children with bleeding disorders both clinically and with child oral health related quality of life questionnaire score. To assess the effect of intervention (education and any necessary dental procedure) on the child oral health related quality of life questionnaire score. Patients and Methods This cross-sectional study was conducted on 70 patients aged from (2-18 years), males represent n = 47 (67.1%), females n = 23 (32.9%). Inherited bleeding disorders represent n = 37 (52.9%) and acquired bleeding disorders represent n = 33 (47.1%). ITP n = 33 (47.1%), hemophilia A n = 27 (38.6%), Von Willebrand’s disease n = 7 (10%) and Glanzmann n = 3 (4.3%) and all subjected to full history taking, examination, dental health estimation, oral health education, dental management and replacement therapy as needed at baseline and after 6 months of follow up from October 2021 to April 2022. ITP bleeding score (ISTH SSC bleeding assessment tool) used to assess severity of ITP patients. Child oral health related quality of life and child oral health impact profile questionnaires were filled by patients/parents at base line and after 6 months follow up. Results The current study revealed that (57.1%) of patients have dental caries. Regarding oral hygiene status, (10%) of patients have poor oral hygiene. Regarding gingival health, (50%) of patients have moderate gingivitis and (11.4%) have severe gingivitis. Oral symptomatology, Psychological domain for child, Psychological domain for family, Social domain for child and Total oral health score were significantly affected more with long duration of disease (p-value =0.0005, 0.0015, 0.010, 0.022 and 0.0045 respectively). There was statistically significant improvement in oral health related quality of life questionnaire score after 6 months of follow up with total oral health score (p-value = 0.000). Conclusion Oral health was significantly affected among patients with acquired and inherited bleeding disorders. Oral health education and management had significant impact on oral health related quality of life scores after 6 months of follow up.

Combining SSRIs With Oral Anticoagulants May Increase Bleeding Risk

Combining SSRIs With Oral Anticoagulants May Increase Bleeding Risk

Assessment of oral hygiene and quality of life in rehabilitated patients with fixed parcial dentures.

Analyze the influence of oral hygiene guidance for the maintenance of fixed partial dentures (FPD) and the influence of this treatment on the quality of life (QL) of rehabilitated patients. The Simplified Oral Hygiene Index (OHI-S) and Bleeding on Probing Index (BOP) methods was employed to evaluate oral hygiene (OH), and the OHIP-14 questionnaire to assessment QL. The sample consisted of 33 patients (26 females and 7 males, mean age 51.53 years) in treatment with FPD. The OH and QL assessments were conducted in temporary FPD placing session and 30 days after definitive cementation. R e s u l t s: OHI-S and BOP showed increasing results (p <0.05) comparing initial and final assessments. There was a negative correlation between OHI-S and BOP, in both periods of analysis. The OHIP-14 showed a significant result according to the Likert scale scores, with an impact reduction from 9.33 to 0.57. It was concluded that FPD rehabilitations need of properly oral hygiene guidance, that could be influence on oral health status. In addition, the FPD rehabilitation improved the QL of the patients.

Treatment of oral graft-versus-host disease with intraoral nbUVB phototherapy.

There are limited treatment options available for hematopoietic stem-cell transplant patients (HSCT) with oral graft-versus-host disease (GVHD). Intraoral phototherapy is a novel, yet promising therapeutic regimen. To assess the safety and effectiveness of intraoral narrowband UVB (nbUVB) phototherapy in the treatment of oral GVHD. This case series evaluated 10 patients with refractory oral GVHD, who were treated at Northwestern Memorial Hospital with nbUVB between July 2019 and October 2023. Primary outcomes were to evaluate the safety and efficacy of phototherapy. Efficacy was measured by objective improvement in symptom scores and subjective improvement in patient reported symptoms. Safety was determined by the withdrawal due to adverse events. Total nbUVB exposure, number of treatments, and change in systemic immunosuppressive medications were also examined. The study cohort comprised 10 patients who developed oral GVHD at a median of 9.5months after HSCT. The total median dose of nbUVB was 36J/cm2, and the median number of sessions was 55. All 10 patients demonstrated some degree of improvement in symptoms. Notably, there was a reduction in the number of patients who reported symptoms of oral pain (83%), bleeding (67%), xerostomia (50%), and oral sensitivity (78%) after initiating phototherapy. There was also a statistically significant decrease in the levels of pain, erythema, and edema (p ≤ 0.001, < 0.001, 0.01, respectively). Most patients tolerated phototherapy well, but 1 patient withdrew from treatment due to adverse effects. Seventy-five percent of patients who were on immunosuppressive medications were able to decrease or stop these medications. This case series suggests that nbUVB phototherapy is well tolerated and efficacious in patients with oral GVHD.

Proactive monitoring of drug–drug interactions between direct oral anticoagulants and small-molecule inhibitors in patients with non-small cell lung cancer

BackgroundSmall-molecule inhibitors (SMIs) have revolutionised the treatment of non-small cell lung cancer (NSCLC). However, SMI-induced drug–drug interactions (DDIs) with frequently co-administered direct oral anticoagulants (DOACs), increase thromboembolic and bleeding risks. This study investigated and proactively managed the consequences of DOAC-SMI DDIs.MethodsThis prospective, observational study enrolled patients with NSCLC concomitantly using a DOAC and SMI. The primary outcome was the proportion of patients with DOAC plasma trough (Ctrough) and peak (Cpeak) concentrations outside expected ranges. Secondary outcomes included DOAC treatment modifications, incidence of bleeding and thromboembolic events and feasibility evaluation of pharmacokinetically guided DOAC dosing.ResultsThirty-three patients were analysed. Thirty-nine percent (13/33) had DOAC Ctrough and/or Cpeak were outside the expected ranges in 39% (13/33). In 71% (5/7) of patients with DOAC concentrations quantified before and during concurrent SMI use, DOAC Ctrough and/or Cpeak increased or decreased >50% upon SMI initiation. In all patients in whom treatment modifications were deemed necessary, DOAC concentrations were adjusted to within the expected ranges.ConclusionProactive monitoring showed that a substantial proportion of patients had DOAC concentrations outside the expected ranges. DOAC concentrations were successfully normalised after treatment modifications. These results highlight the importance of proactive monitoring of DOAC-SMI DDIs to improve treatment in patients with NSCLC.

Mandibular Fracture in a Newborn From Birth Trauma: A Case Report

Objective: To report a case of mandibular fracture in a newborn presenting with post-delivery oral cavity bleeding and to discuss its etiology, clinical findings, diagnosis, management and outcome after treatment. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A newborn girl was referred for oral cavity bleeding after partial breech extraction. An intraoral hematoma and symphyseal step deformity on examination corresponded to a complete fracture of the symphysis and downward displacement of the left hemimandible on facial CT scans with 3D reconstruction. An uneventful closed reduction with external fixation using acrylic cap splint with circum-mandibular wiring was performed under general anesthesia and she was discharged feeding well. The cap splint and wires were removed after 4 weeks showing good facial symmetry and bone alignment. There were no complications on follow-up after 1 year. Conclusion: Mandibular fracture can result from traumatic delivery and present with oral bleeding and hematoma. A thorough physical examination and workup should be done to assess for the sites involved. A multidisciplinary approach should be undertaken to provide the best possible care with the least invasive technique.

#3051 Light chain only variant of proliferative glomerulonephritis with monoclonal immunoglobulin deposits: a case report

Abstract Background and Aims Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is an entity characterized by glomerular deposition of monoclonal immunoglobulins, typically IgG. Recently, a cohort of 17 patients presenting with light chain only variant of PGNMID was published. Strikingly, in this cohort, glomerular deposition of C3 was detected in all cases. We herein report a case of PGNMID with a rare presentation on the kidney biopsy. Case presentation We present the case of a 73-year-old female with a past medical history of rheumatoid arthritis and hypertension, under methotrexate 10 mg per week, prednisone 2.5 mg per day, amlodipine, nebivolol, azilsartan, and a recurrent naproxen intake. She presented with fatigue, anorexia, weight loss of about 12% of her body weight, epistaxis, oral bleeding ulcers, and lower extremities oedema. Pancytopenia, acute kidney injury (urea 150 mg/dL, creatinine 2.92 mg/dL), and nephrotic syndrome (serum albumin of 2.7 mg/dL and proteinuria of 12 g/day) were noted. Further evaluation showed an imbalance of the free light chains’ ratio with kappa light chain's level of 1250 mg/dL. Serum protein electrophoresis and immunofixation were normal. A CT scan showed numerous cervical, mediastinal, and iliac enlarged lymph nodes. Kidney biopsy showed an increase in mesangial cells and matrix and capillary walls’ thickening without nodular lesions under a light microscope. Immunofluorescence microscopy showed granular deposits of kappa light chains and no deposition IgA, IgG, IgM, C1q, C3, fibrin and lambda. Considering the previous literature, C3 was reanalyzed, with a consistent negative staining. Based on the above findings, a diagnosis of Light chain only variant of PGNMID was made. Concomitantly, evaluation of the bone marrow sample showed Small lymphocytic lymphoma. The patient was started on Bortezomib, cyclophosphamide and dexamethasone. Three months after proteinuria was 0.47 g/g and creatinine 1.7 mg/dL. Conclusion This case highlights the rare occurrence of a PGNMID with light chains only deposition (without C3 co-deposition) as a complication of small lymphocytic lymphoma. This contributes to the growing body of evidence surrounding this entity, with the particularity being that C3 was not detected. The authors hypothesized some pathophysiologic mechanisms to justify the absence of C3 co-deposition.

Direct oral anticoagulant-associated bleeding complications in patients with gastrointestinal cancer and venous thromboembolism

BackgroundDirect oral anticoagulants (DOACs) have become widely used for cancer-associated venous thromboembolism (VTE). However, DOAC-associated bleeding complications remain challenging, especially in patients with gastrointestinal (GI) cancer. This study aimed to compare the bleeding outcomes between patients with upper or lower GI cancers and those without GI cancer. MethodsUsing the COMMAND VTE Registry-2 database, which is a multicenter registry enrolling 5197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020, we identified 1149 active cancer patients with DOACs (upper GI cancer: N = 88; lower GI cancer: N = 114; non-GI cancer: N = 947). The primary outcome was major bleeding during anticoagulation therapy, which was evaluated in the competing risk regression model. ResultsThe upper GI cancer group had a lower mean body weight, and most often had anemia. The cumulative 5-year incidence of major bleeding was higher in the upper GI cancer group (upper GI cancer: 22.4 %, lower GI cancer: 15.4 %, and non-GI cancer: 11.6 %, P = 0.015). The most frequent major bleeding site in the upper GI cancer group was the upper GI (53 %), followed by the lower GI (24 %). After adjusting for the confounders, the excess risk in upper GI cancer relative to non-GI cancer remained significant for major bleeding (adjusted subhazard ratio, 2.25; 95 %CI, 1.31–3.87, P = 0.003), but that in lower GI cancer was insignificant. ConclusionsUpper GI cancer, but not lower GI cancer, as compared to non-GI cancer was associated with a higher risk for major bleeding during anticoagulation therapy with DOACs.Clinical Trial Registration: URL: http://www.umin.ac.jp/ctr/index.htmUnique identifier: UMIN000044816.

Postoperative Morbidity after Dental Treatment under General Anesthesia in Children with and without Disabilities.

Background and Objectives: General anesthesia induces reversible unconsciousness, eliminating sensation and enabling painless medical procedures. Vital for dental care, it addresses patients with medical conditions, those needing extensive procedures, and those unable to cooperate due to fear. Dental care for patients with disabilities is a significant unmet need, with studies showing increased oral disease prevalence. This research aims to analyze postoperative morbidity both in healthy and disabled children undergoing dental procedures under general anesthesia. Materials and Methods: This study involved 96 children aged 3 to 15 with dental caries. Two groups were formed: the control group (CTL) (52.94%) included healthy patients requiring general anesthesia due to unsatisfactory cooperation, and the other group included children with physical or intellectual disabilities (CD) (47.96%). Postoperative complications were monitored 1 h after the procedure and 1, 3, 7, and 14 days after the procedure by contacting parents/caregivers by phone. The intensity of postoperative pain was assessed using the Wong-Baker faces pain rating scale. General anesthesia was conducted following a standardized protocol for dental procedures. Results: CTL patients complained more often about postoperative pain 1 h after the procedure (p = 0.03). One day after the procedure, oral bleeding (p = 0.04), fever (p = 0.009), and diarrhea (p = 0.037) occurred more often in CD. In the same period, sore throat appeared more often in CTL (p = 0.036). Three days after the dental treatment, there were statistically significant increases in the occurrence of agitation (p = 0.043) and constipation (p = 0.043) in CD. Seven days later, CD demonstrated a higher occurrence of agitation (p = 0.037). According to the Wong-Baker faces pain rating scale, CTL experienced more frequent and intense pain. Conclusions: CD more frequently reported complications like oral bleeding, fever, and diarrhea. In contrast, the CTL group more often reported pain-related symptoms. The conclusion underscores the need for a pain control protocol for CD and emphasizes the importance of frequent monitoring to prevent unwanted consequences during tooth restoration under general anesthesia.