## 4 Discussion
### Acquired coagulopathies
#### 4.8.2 Oral Anticoagulants
\begin{table}
\begin{tabular}{c c c c} \hline
**Authors and Year of** & **Haemostasis** & & \\
**Publication** & **Pathologies** & **Operational Suggestions in Oral Surgery** \\ \hline  & & - & Local anaesthetics may have little or no effect in some patients, due to tissue scarring that determines a reduced diffusion of local anaesthetics. This includes the use of EMLA cream as a topical anaesthetic. \\  & & - & Tests of coagulation usually give results in the normal range, but the clotting time may be prolonged, particularly in patients who have already had bleeding episodes in their medical history \\ [PERSON] et al. (2005) & Ehlers-Danlos syndrome & - & Attention is needed in the mobilization of patients with EDS, as they are prone to easy skin lesions and hematoma formation. Ease of dislocation of the joints should also be remembered with specific regard to the temporomandibular joint \\  & & - & Wound and bone remodelling are impaired \\ \hline  & & - & The presence of pulmonary AVM exposes patients to the risk of introducing bacteria into the bloodstream, especially during some invasive medical, surgical, or dental procedures. Antibiotical prophylaxis is required \\ [PERSON] et al., 2008 (29) & Weber-Osler-Rendu & - & Small AVMs can be treated with laser therapy \\ [PERSON] et al., 2008 (29) & syndrome & - & No precautions are required regarding local anaesthesia, and no formal contraindications to the use of drugs \\  & & - & Transfusions of platelet concentrate should be considered when the platelet count falls under 20–30 \(\times\) 10\({}^{9}\)/\(\mu\)L during dentistry (calculus removal, root planing), 30 \(\times\) 10\({}^{9}\)/\(\mu\)L during simple extractions, 50 \(\times\) 10\({}^{9}\)/\(\mu\)L during complex extractions 30 \(\times\) 10\({}^{9}\)/\(\mu\)L during locoregional (troncular) \\  & & anaesthesia, 50 \(\times\) 10\({}^{9}\)/\(\mu\)L during small oral surgery, 80 \(\times\) 10\({}^{9}\)/\(\mu\)L during major oral surgery (complex interventions) \\ [PERSON] et al., 2005 (38) & Idiopathic thrombocytopenia pumpura (ITP) & - & An anticoagulant strategy is not needed, except in the case of other comorbidities, such as thrombosis, stenting, or heart valve disease \\  & & - & Preoperative planning of surgery in patients that takes anticoagulants should include the regulation of the anticoagulant drug and/or low molecular weight heparin, in relation to the patient’s health state \\  & & - & Antifibrinolytic agents, such as oral or IV tranexamic acid and \\  & & - & epsilon-aminocaproic acid, may be useful in the prevention of recurrent bleeding in patients with severe thrombocytopenia \\ \hline  & & - & To avoid platelet alloimmunization, therapeutic management should include, if possible, local haematostatic treatments and/or the administration of desmopressin. When these methods are ineffective, or in anticipation of surgery, management is based on the transfusion of HLA-compatible platelet concentrates. The administration of recombinant factor VIA is a new therapeutic alternative that needs to be considered \\ [PERSON] et al., 2010 (46) & [PERSON]’s thrombasthenia & - & GT patients may experience haemorrhage in case of loss of deciduous dentition. In this event, it is necessary to proceed with prolonged compression of the wound and, possibly, the application of haemostatic biological adhesive—use of antifibrinolytic agents (tranexamic acid), locally or systemically \\  & & - & It is necessary to avoid the administration of drugs that aggravate haemostatic disorders and intramuscular injections \\  & & - & Locoregional anaesthesia is discouraged, and prolonged local pressure is recommended after subcutaneous injection to avoid the risk of hematomas \\ \hline  & & - & \\ \end{tabular}
\end{table} 
Table 2: Operational suggestions for hemostasis pathologies in oral surgery.