Platelet Levels Associated With Bleeding Risk for Dental Interventions: A Systematic Review

OBJECTIVES: To evaluate evidence in relation to postoperative bleeding in humans aged ≥ 16 with preoperative platelet counts < 50,000/μL, compared to those above, undergoing dental interventions. METHODS: Quantitative synthesis without meta-analysis was conducted through an electronic search conducted on Ovid MEDLINE and Embase from 1946 to April 2024 with no restriction on study design. Primary outcome was postoperative bleeding in patients with platelet count < 50,000/μL due to dental interventions. Two reviewers assessed independently, and a third resolved conflicts. This study was reported according to PRISMA 2020 and registered on PROSPERO (CRD42024527279). RESULTS: 1633 unique articles were identified. Six case reports, four case series, nine cohort studies and one trial fulfilled the inclusion. Overall, 983 included cases consisted of 968 oral surgery, 10 periodontology and 5 dental anaesthesia cases. Postoperative bleeding occurred in 65 cases following oral surgery procedures, of which 1 was life-threatening. Bleeding rates for cases with platelet levels < 50,000/μL were 12.9%, and 4.9% for ≥ 50,000/μL. Risk ratio was 2.95 (95% CI: 1.76-4.96; p < 0.0001). CONCLUSIONS: There is no evidence that platelet counts < 50,000/μL is a contraindication for dental interventions, although findings suggest higher postoperative bleeding rates, particularly in oral surgery. Patients should be assessed individually, with more controlled trials required.