{"id":7484,"date":"2026-10-15T06:00:00","date_gmt":"2026-10-15T06:00:00","guid":{"rendered":"https:\/\/www.belodonte.es\/?p=7484"},"modified":"2026-08-03T09:27:49","modified_gmt":"2026-08-03T09:27:49","slug":"trombosi-cirurgia-oral-com-gestionar-lanticoagulacio-abans-duna-intervencio","status":"publish","type":"post","link":"https:\/\/www.belodonte.es\/ca\/trombosi-cirurgia-oral-com-gestionar-lanticoagulacio-abans-duna-intervencio\/","title":{"rendered":"Trombosi i cirurgia oral: com gestionar l&#8217;anticoagulaci\u00f3 abans d&#8217;una intervenci\u00f3"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">La<strong> trombosi <\/strong>venosa i les malalties cardiovasculars que requereixen tractament anticoagulant o antiagregant s\u00f3n patologies d&#8217;alta prevalen\u00e7a en la poblaci\u00f3 adulta, especialment a partir dels 50 anys. La gesti\u00f3 d&#8217;aquests f\u00e0rmacs abans d&#8217;una intervenci\u00f3 de cirurgia oral \u00e9s un dels escenaris cl\u00ednics m\u00e9s freq\u00fcents i m\u00e9s complexos en la pr\u00e0ctica odontol\u00f2gica especialitzada. L&#8217;equilibri entre el risc hemorr\u00e0gic de mantenir l&#8217;anticoagulaci\u00f3 i el risc tromboemb\u00f2lic de suspendre-la requereix un protocol cl\u00ednic individualitzat i coordinat entre el cirurgi\u00e0 oral i el metge prescriptor.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quins f\u00e0rmacs anticoagulants i antiagregants s&#8217;usen amb m\u00e9s freq\u00fc\u00e8ncia?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">L&#8217;arsenal de f\u00e0rmacs que afecten l&#8217;hemost\u00e0sia \u00e9s ampli i en constant expansi\u00f3. \u00c9s fonamental que el cirurgi\u00e0 oral conegui amb precisi\u00f3 quina presa el pacient abans de planificar qualsevol intervenci\u00f3.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Els antiagregants plaquetaris m\u00e9s utilitzats s\u00f3n l&#8217;\u00e0cid acetilsalic\u00edlic (AAS) en dosis baixes (100 mg\/dia) i el clopidogrel, solos o en combinaci\u00f3 (doble antiagregaci\u00f3), especialment en pacients amb stents coronaris o s\u00edndromes coron\u00e0ries agudes recents.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Els anticoagulants orals cl\u00e0ssics (antagonistes de la vitamina K) inclouen l&#8217;acenocumarol (Sintrom) i la warfarina, l&#8217;efecte de la qual es monitora mitjan\u00e7ant el INR (quocient internacional normalitzat).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Els anticoagulants orals d&#8217;acci\u00f3 directa (ACOD), tamb\u00e9 anomenats nous anticoagulants orals (NACO), inclouen el dabigatran (inhibidor directe de la trombina) i el rivaroxaban, l&#8217;apixaban i l&#8217;edoxaban (inhibidors del factor Xa). No requereixen monitoratge rutinari del INR, per\u00f2 tenen unes caracter\u00edstiques farmacocin\u00e8tiques espec\u00edfiques que condicionen el seu maneig peroperatori.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Les heparines de baix pes molecular (HBPM) com l&#8217;enoxaparina s&#8217;utilitzen habitualment com a pont anticoagulant o en el tractament agut de la trombosi venosa profunda.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quin risc hemorr\u00e0gic tenen els procediments de cirurgia oral habituals?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">No tots els procediments de cirurgia oral tenen el mateix potencial hemorr\u00e0gic, i la classificaci\u00f3 del risc \u00e9s el primer pas per a determinar l&#8217;estrat\u00e8gia de maneig peroperatori.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Els procediments de baix risc hemorr\u00e0gic inclouen les extraccions simples d&#8217;un a tres dents, la cirurgia periodontal menor, les bi\u00f2psies de teixit tou superficial i la col\u00b7locaci\u00f3 d&#8217;implants unitaris en zones sense comprom\u00eds vascular. En aquests casos, l&#8217;evid\u00e8ncia cient\u00edfica actual recolza fermament la no interrupci\u00f3 del tractament anticoagulant o antiagregant, amb mesures hemost\u00e0tiques locals (sutura herm\u00e8tica, esponges de col\u00b7lagen, \u00e0cid tranex\u00e0mic t\u00f2pic) com a estrat\u00e8gia de control del sagnat.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Els procediments de risc hemorr\u00e0gic moderat-alt inclouen les extraccions m\u00faltiples, la cirurgia de queixals de l&#8217;enteniment amb ostectomia extensa, la cirurgia d&#8217;implants amb regeneraci\u00f3 \u00f2ssia guiada, les elevacions de si maxil\u00b7lar i les reseccions de tumors orals. En aquests casos, la decisi\u00f3 de mantenir, reduir o suspendre temporalment el f\u00e0rmac ha de prendre&#8217;s de manera individualitzada, valorant el risc tromboemb\u00f2lic del pacient.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quan est\u00e0 justificat suspendre el tractament anticoagulant abans de cirurgia oral?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">La interrupci\u00f3 del tractament anticoagulant abans de cirurgia oral \u00e9s una decisi\u00f3 que mai ha de prendre&#8217;s de manera unilateral pel cirurgi\u00e0 oral, sin\u00f3 sempre en coordinaci\u00f3 amb la metge prescriptor (cardi\u00f2leg, hemat\u00f2leg o metge de cap\u00e7alera).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En els pacients amb acenocumarol o warfarina, el valor del INR en el moment de la intervenci\u00f3 \u00e9s el par\u00e0metre m\u00e9s rellevant. Els consensos cient\u00edfics actuals estableixen que valoris de INR de fins a 3,5 s\u00f3n acceptables per a la majoria dels procediments de cirurgia oral de baix risc quan es combinen amb mesures hemost\u00e0tiques locals adequades. No existeix evid\u00e8ncia que justifiqui la suspensi\u00f3 rutin\u00e0ria del Sintrom per a extraccions simples.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En els pacients amb ACOD, el maneig dep\u00e8n del f\u00e0rmac espec\u00edfic, de la funci\u00f3 renal del pacient (que determina la velocitat d&#8217;eliminaci\u00f3 del f\u00e0rmac) i del risc hemorr\u00e0gic del procediment. Per a procediments de baix risc, pot ser suficient realitzar la intervenci\u00f3 a la vall d&#8217;acci\u00f3 del f\u00e0rmac (12-24 hores despr\u00e9s de l&#8217;\u00faltima dosi), sense suspensi\u00f3. Per a procediments de risc m\u00e9s alt, pot ser necess\u00e0ria una interrupci\u00f3 de 24-48 hores pr\u00e8via, sempre sota supervisi\u00f3 m\u00e8dica.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En els pacients amb doble antiagregaci\u00f3 per stent coronari recent, la suspensi\u00f3 de qualsevol dels dos antiagregants comporta un risc de trombosi del stent que pot ser fatal, per la qual cosa la cirurgia oral electiva ha de posposar-se fins a completar el per\u00edode m\u00ednim de doble antiagregaci\u00f3 recomanat per cardiologia.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quines mesures hemost\u00e0tiques locals s&#8217;utilitzen en cirurgia oral?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Les mesures hemost\u00e0tiques locals s\u00f3n la clau per a realitzar cirurgia oral segura en pacients anticoagulants sense necessitat de suspendre el seu tractament en la majoria dels casos.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La sutura herm\u00e8tica de la ferida quir\u00fargica \u00e9s la mesura m\u00e9s efica\u00e7: tanca el llit cruent i facilita la formaci\u00f3 i estabilitzaci\u00f3 del co\u00e0gul.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Les esponges de col\u00b7lagen o gelatina reabsorbible col\u00b7locades en l&#8217;alv\u00e8ol abans de suturar actuen com a bastimentada per a la formaci\u00f3 del co\u00e0gul i exerceixen pressi\u00f3 hemost\u00e0tica local.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">L&#8217;\u00e0cid tranex\u00e0mic en esbandida (10 ml de soluci\u00f3 al 5%, durant dos minuts, quatre vegades al dia durant els primers dies postoperatoris) \u00e9s un antifibrinol\u00edtic t\u00f2pic que estabilitza el co\u00e0gul format i redueix significativament el sagnat postoperatori en pacients anticoagulants. La seva efic\u00e0cia est\u00e0 recolzada per m\u00faltiples assajos cl\u00ednics aleatoritzats.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La cera per a os, el plasma ric en factors de creixement (PRGF) i les f\u00e8rules d&#8217;acr\u00edlic compressives s\u00f3n recursos addicionals que poden utilitzar-se en casos de complexitat hemost\u00e0tica m\u00e9s alta.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quina informaci\u00f3 ha de proporcionar el pacient abans de la intervenci\u00f3?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">La informaci\u00f3 preoperat\u00f2ria que el pacient ha d&#8217;aportar \u00e9s fonamental per a una planificaci\u00f3 quir\u00fargica segura.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El nom exacte i la dosi del f\u00e0rmac o f\u00e0rmacs anticoagulants o antiagregants que presa. La indicaci\u00f3 m\u00e8dica per la qual els pren (fibril\u00b7laci\u00f3 auricular, trombosi venosa profunda, stent coronari, v\u00e0lvula card\u00edaca mec\u00e0nica). L&#8217;\u00faltim valor de INR disponible, en el cas dels pacients amb acenocumarol o warfarina, amb la data en qu\u00e8 es va realitzar l&#8217;anal\u00edtica. La funci\u00f3 renal (creatinina i filtrat glomerular), especialment rellevant en els pacients amb ACOD. I el nom de la metge prescriptor, per a facilitar la coordinaci\u00f3 si fos necess\u00e0ria.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En Cl\u00ednica Belodonte el formulari d&#8217;hist\u00f2ria cl\u00ednica preoperat\u00f2ria recull de manera sistem\u00e0tica tota aquesta informaci\u00f3 i permet planificar el protocol hemost\u00e0tic adequat per a cada cas abans del dia de la intervenci\u00f3.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Qu\u00e8 fer si apareix sagnat excessiu despr\u00e9s de la cirurgia oral?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Un sagnat postoperatori moderat durant les primeres hores despr\u00e9s de la cirurgia \u00e9s esperable i no constitueix per si mateix una complicaci\u00f3. El pacient ha de pressionar amb una gasa doblegada sobre la zona durant 20-30 minuts de manera cont\u00ednua, sense retirar-la intermitentment per a comprovar si continua sagnant.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Si el sagnat no cedeix amb la pressi\u00f3, augmenta de manera progressiva, s&#8217;acompanya de la formaci\u00f3 de grans co\u00e0guls en la boca o persisteix m\u00e9s de dues hores, el pacient ha de contactar amb la cl\u00ednica o acudir a urg\u00e8ncies. En aquests casos, la revisi\u00f3 de la ferida quir\u00fargica, el refor\u00e7 de la sutura i l&#8217;aplicaci\u00f3 de mesures hemost\u00e0tiques addicionals (\u00e0cid tranex\u00e0mic t\u00f2pic, esponges hemost\u00e0tiques) solen ser suficients per a controlar el sagnat sense necessitat de suspendre el tractament anticoagulant.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Preguntes freq\u00fcents sobre anticoagulaci\u00f3 i cirurgia oral<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Haig de deixar de prendre el Sintrom abans d&#8217;una extracci\u00f3 dental?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En la majoria dels casos, no. L&#8217;evid\u00e8ncia cient\u00edfica actual \u00e9s clara: l&#8217;extracci\u00f3 dental simple en pacients amb INR en rang terap\u00e8utic (fins a 3,5) pot realitzar-se de manera segura sense suspendre l&#8217;acenocumarol, sempre que s&#8217;apliquin mesures hemost\u00e0tiques locals adequades. La suspensi\u00f3 del Sintrom abans d&#8217;una extracci\u00f3 augmenta el risc de complicacions tromboemb\u00f2liques sense reduir de manera significativa el risc de sagnat si s&#8217;utilitzen correctament les mesures locals.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">El ibuprof\u00e8n interfereix amb els anticoagulants?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">S\u00ed. Els antiinflamatoris no esteroidals (AINEs) com el ibuprof\u00e8n tenen efecte antiagregant plaquetari i poden potenciar l&#8217;efecte dels anticoagulants, augmentant el risc de sagnat. En pacients anticoagulants, el paracetamol \u00e9s l&#8217;analg\u00e8sic de primera elecci\u00f3 per al control del dolor postoperatori. Si fos necessari un antiinflamatori, ha de consultar-se amb la metge prescriptor.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Qu\u00e8 passa si m&#8217;oblido de dir-li al cirurgi\u00e0 que prenc anticoagulants?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Un sagnat postoperatori excessiu pot ser la conseq\u00fc\u00e8ncia, amb la necessitat d&#8217;una intervenci\u00f3 addicional per a controlar-ho. M\u00e9s important encara: si el cirurgi\u00e0 no coneix el teu tractament anticoagulant, no pot planificar el protocol hemost\u00e0tic adequat ni coordinar amb el teu metge si calgu\u00e9s. Comunicar sempre i de manera completa la medicaci\u00f3 habitual \u00e9s una responsabilitat del pacient que t\u00e9 un impacte directe sobre la seva seguretat.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Els implants dentals poden col\u00b7locar-se en pacients anticoagulados?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">S\u00ed, amb la planificaci\u00f3 adequada. La col\u00b7locaci\u00f3 d&#8217;implants dentals en pacients anticoagulants \u00e9s factible i segura quan es valora correctament el risc hemorr\u00e0gic del cas espec\u00edfic, s&#8217;optimitzen les mesures hemost\u00e0tiques locals i es coordina amb la metge prescriptor quan la complexitat del cas el requereix. L&#8217;anticoagulaci\u00f3 no \u00e9s una contraindicaci\u00f3 absoluta per a la implantologia, sin\u00f3 un factor de risc que ha de gestionar-se de manera activa.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Si prens anticoagulants i necessites una intervenci\u00f3 oral, no la posterguis per por del sagnat. Informa&#8217;ns del teu tractament des del primer moment i planificarem junts la intervenci\u00f3 m\u00e9s segura per a tu.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>La trombosi venosa i les malalties cardiovasculars que requereixen tractament anticoagulant o antiagregant s\u00f3n patologies d&#8217;alta prevalen\u00e7a en la poblaci\u00f3 adulta, especialment a partir dels 50 anys. La gesti\u00f3 d&#8217;aquests f\u00e0rmacs abans d&#8217;una intervenci\u00f3 de cirurgia oral \u00e9s un dels [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":7483,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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