Scripties UMCG - Rijksuniversiteit Groningen
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A dose dependent relationship between periodontitis and hypercoagulability: the Periodontitis Increases Risk of AcuteThrombotic Events (PIRATE) study : (An unplanned interim analysis)

(2016) Aapkes, S.E (Sophie Elise)

Introduction: Venous thrombo-embolism occurs in about 1:1000 people every year and can lead to disabling complications or in some cases, death. A substantial part of venous thrombo-embolism cases is still unexplained. The last decades, infection and inflammation are recognized as acquired risk factors for venous thrombosis. Periodontitis is a chronic inflammatory condition of the surrounding tissues of the teeth, that is relatively common in the population. In this observational study, we study the influence of periodontitis on coagulation values by measuring coagulation values before and after extraction of all teeth, so in presence and absence of severe periodontitis, in a patient population already eligible for this intervention. Methods: Patient recruitment took place at the department of oral and maxillofacial surgery of the University Medical Center of Groningen (UMCG). An unplanned interim analysis was performed using the 18 patients that already had completed the study. Severity of periodontitis was assessed directly before extraction of all teeth using PISA scores. Blood samples were obtained before intervention and three months thereafter. Thrombin Generation tests (with and without thrombomodulin) were performed using Calibrated Automated Thrombography (CAT). Furthermore, D-dimer (Hemosil HS 500) and Factor VIII were measured. Results:. In patients with PISA-scores > 2000 mm2, thrombin generation without thrombomodulin and D-dimer showed a significant decrease after intervention. Linear regression showed that the severity of periodontitis (PISA scores) had significant influence on the decline in coagulation values after intervention for thrombin generation without thrombomodulin and D-dimer. Factor VIII values were not influenced by periodontitis. Conclusion: A dose dependent relationship was observed between periodontitis severity and levels of D-dimer and thrombin generation without thrombomodulin. Thrombin generation with thrombomodulin was probably non-significant due to a lack of power. Only in very severe periodontitis patients, the influence of periodontitis on coagulation could possibly be clinical relevant, but more research has to be done.

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