From the Guidelines
A patient on Ruxolitinib can generally undergo dental extraction surgery, but special precautions should be taken to minimize bleeding and infection risks. The patient should inform their hematologist/oncologist about the planned dental procedure at least one week in advance. Ruxolitinib, a JAK1/2 inhibitor used for myelofibrosis, polycythemia vera, and certain inflammatory conditions, can affect blood cell counts and immune function. Some key considerations for the procedure include:
- Obtaining recent complete blood count results before proceeding, as patients may have thrombocytopenia (low platelets) which increases bleeding risk 1.
- If platelet counts are below 50,000/μL, the procedure may need to be postponed or platelet transfusion considered.
- The patient should continue taking Ruxolitinib as prescribed unless specifically instructed otherwise by their hematologist, as sudden discontinuation can cause withdrawal symptoms.
- Post-extraction, extended hemostatic measures may be needed, and the patient should be monitored closely for infection, as Ruxolitinib can impair immune function 1.
- Prophylactic antibiotics might be prescribed depending on the patient's overall condition and infection risk. Good communication between the dental provider and the patient's hematologist/oncologist is essential to ensure safe management, as seen in guidelines for managing antithrombotic therapy during dental procedures 2. Dental surgery is generally considered a procedure with minor bleeding risk and with the possibility for adequate local haemostasis, and most professional statements advise not to suspend treatment and avoid the use of NSAIDs 1. However, recommendations are often based on a low quality of evidence and mainly rely on available pharmacological information. Dental extractions can generally be performed safely in an outpatient facility by applying adequate local measures, similar to the approach for patients on non-vitamin K antagonist oral anticoagulants 3, 1.
From the Research
Dental Extraction and Ruxolitinib
- There are no direct studies on patients taking Ruxolitinib (Jakafi, Janus kinase inhibitor) undergoing surgical dental extraction.
- However, studies on patients with bleeding disorders or those taking anticoagulants/antiplatelet therapy can provide some insights: + A study on Glanzmann thrombasthenia, a rare genetic disorder that alters platelet function, found that the use of oral tranexamic acid associated with a single platelet bag was effective in preventing bleeding after surgical procedures, including dental extractions 4. + A prospective case-control study on patients taking new oral anticoagulants (NOACs) found that skipping the morning dose of NOACs avoids excess bleeding during and early after dental extraction, but anticoagulated patients had an increased risk of delayed bleedings 5. + A randomized, double-blind, placebo-controlled trial (EXTRACT-NOAC) is investigating whether tranexamic acid mouthwash decreases bleeding after dental extraction in patients treated with NOACs 6. + A retrospective cohort study found that dental extraction without stopping single or dual antiplatelet therapy did not significantly increase the incidence of postoperative bleeding, and that tranexamic acid powder can be used to manage bleeding 7. + A study on managing anticoagulant patients undergoing dental extraction using tranexamic acid mouthrinse found that it is an effective way to control bleeding in patients with therapeutic INR levels 8.
Considerations for Dental Extraction
- Patients taking Ruxolitinib may require special consideration due to the potential risk of bleeding.
- The use of hemostatic agents, such as tranexamic acid, may be effective in controlling bleeding after dental extraction.
- Close monitoring and collaboration with a hematologist or other specialist may be necessary to minimize the risk of complications.