MANAGEMENT OF PERIOPERATIVE BLEEDING IN PATIENTS WITH PLATELET HYPOAGGREGABILITY DURING DENTOALVEOLAR SURGERY: CLINICAL OUTCOMES AND THERAPEUTIC APPROACHES.

BACKGROUND: Perioperative bleeding is a clinically important complication in patients with platelet hypoaggregability undergoing tooth extraction and minor dentoalveolar surgery. Impaired platelet aggregation may result in prolonged bleeding despite normal routine coagulation tests. AIM: This study aimed to evaluate perioperative bleeding outcomes and the effectiveness of a standardized tranexamic acid (TXA)-based protocol in patients with laboratory-confirmed platelet hypoaggregability undergoing dentoalveolar surgical procedures. MATERIAL AND METHODS: This retrospective observational clinical study analyzed data from 64 patients with laboratory-confirmed platelet hypoaggregability and 64 healthy controls treated between January 2019 and December 2024 at the University Clinic for Maxillofacial Surgery, Skopje. Patients receiving chronic anticoagulant or antiplatelet therapy were not included in the present analysis. Platelet aggregation was assessed using ADP, collagen and ristocetin. Patients with platelet hypoaggregability received intravenous TXA at a dose of 10 mg/kg approximately 30 minutes before surgery, combined with local hemostatic measures. RESULTS: Patients with platelet hypoaggregability demonstrated prolonged bleeding history and significantly reduced platelet aggregation values. Mean ADP-, ristocetin- and collagen-induced aggregation values were 36.9±13.3%, 61.4±14.0% and 49.1±15.5%, respectively. Bleeding duration was inversely correlated with ADP (r=-0.346, p=0.005) and ristocetin values (r=-0.275, p=0.028). Following TXA administration, no moderate or severe postoperative bleeding was recorded, and complete hemostasis was achieved in 98.4% of cases. CONCLUSION: Platelet hypoaggregability is an important risk factor for prolonged post-extraction bleeding. A standardized perioperative protocol based on platelet aggregation assessment, intravenous TXA at 10 mg/kg and local hemostatic measures appears safe and effective for dentoalveolar surgery in this patient group.