EXODONTIA EM PACIENTES SUBMETIDOS A TERAPIA COM OS NOVOS ANTICOAGULANTES ORAIS DIRETOS
Palavras-chave:
anticoagulantes, extração dentária, hemorragia, odontologia
Resumo
A incidência no número de pacientes submetidos a terapia anticoagulante tem aumentado. Nesse cenário, os NAODs vem ganhando preferências na área médica devido às suas vantagens farmacológicas. Este fato culmina na elevação da probabilidade de encontrar indivíduos submetidos a terapia com NAODs encaminhados a exodontia em ambiente ambulatorial. Diante disso, o cirurgião-dentista enfrenta o impasse entre o risco de hemorragia ao continuar a terapia e episódios de tromboembolismo ao cessá-la. A literatura atual ainda não definiu um protocolo específico para estes casos, mas fornece informações valiosas para a conduta clínica, cirúrgica e farmacológica diante dessas situações.
Referências
1- Nascimento BR, Washizu EKM, Brant LCC, Sousa MR. Terapia Anticoagulante no tratamento das síndromes coronárias agudas: revisão. Rev Med Minas Gerais. 2012 Mar; 22(1): 1-128
2- Spencer RJ, Amerena JV. Rivoroxabana in the Prevention of Stroke and Systemic Embolism in Patients with Non-Valvular Atrial Fibrillation: Clinical Implications of the ROCKET AF Trial and Its Subanalyses. Am J Cardiovasc Drugs. 2015 Jun; DOI 10.1007/s40256-015-0127-2.
3- Hupp JR. Princípios de cirurgia. In: Hupp JR, Ellis III E, Tucker MR Cirurgia Oral e Maxilofacial Contemporânea. 5º edição. São Paulo Elsevier Editora Ltda. 2009. p. 43, 46.
4- Caliskan M, Tükel H, Benlidayi M, Deniz A. Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants? Med Oral Patol Oral Cir Bucal. 2017 Set; 1;22 (6):e767-73.
5- Ruff CT, Braunwald E. Will Warfarin Ever Be Replaced? Journal of Cardiovascular Pharmacology and Therapeutics | February 18 2010
6- Bauer KA. Pros and cons of new oral anticoagulants. American Society of Hematology. 2013 Dez; 2013 (1): 464-470. https://doi.org/10.1182/asheducation-2013.1.464
7- Firriolo FJ, Hupp WS. Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. Elsevier inc. 2012 Abr; 113:431-441
8- Lababidi E, Breik O, Savage J, Engelbrecht H, Kumar R, Crossley CW. Assessing an oral surgery specific protocol for patients on direct oral anticoagulants: a retrospective controlled cohort study. International Association of Oral and Maxillofacial Surgeons. 2018 Mar; YIJOM-3895: 1-7.
9- Yoshikawa H, Yoshida M, Yasaka M, Yoshida H, Murasato Y, Fukunaga D, Shintani A, Okada Y. Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study. Int. J. Oral Maxillofac. Surg. 2019 Jan; YIJOM-4108: 1-7.
10- Miller SG, Miller CS. Direct oral anticoagulants: A retrospective study of bleeding behavior, and documentation. Wiley Oral Diseases. 2018;24:243–248. DOI: 10.1111/odi.12698
11- Mingarro-de-León A, Chaveli-López B. Alternative to oral dicoumarin anticoagulants:Considerations in dental care. Journal section: Odontostomatology for the disabled or special patients. 2013 set;5(5):e273-8. DOI:10.4317/jced.51226.
12- Berton F, Costantinides F, Rizzo R, Franco A, Contarin J, Stacchi C et al. Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study. Springer-Verlag GmbH Germany, part of Springer Nature. 2018 Nov. https://doi.org/10.1007/s00784-018-2739-9
13- Cocero N, Basso M, Grosso S, Carossa S. Direct Oral Anticoagulants (DOACs) and Medical Comorbidities in Patients Needing Dental Extractions: Management of the Risk of Bleeding. Journal of Oral and Maxillofacial Surgery. 2018 Set. DOI: 10.1016/j.joms.2018.09.024
14- Patel JP, Woolcombe SA, Patel RK, Obisesan O, Roberts LN, Bryant C et al. Managing direct oral anticoagulants in patients undergoing dentoalveolar surgery. British Dental Journal. Volume 222 No. 4. 2017 Fev; 222: 245-249. DOI: 10.1038/sj.bdj.2017.165
15- O’Connell JE, Stassen LFA. New oral anticoagulants and their implications for dental patients. Journal of the Irish Dental Association. 2014 Jul; 60 (3): 137-143.
16- Enríquez A, Baranchuk A, Corbalán R. Manejo de hemorragia asociada a anticoagulantes orales directos: estado actual de las estrategias de reversión. Rev Med Chile. 2019; 147: 73-82
17- Vinogradova Y, Coupland C, Hill T, Hippisley-Cox J. Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. The BMJ. 2018 Mai; 362:k2505. DOI: 10.1136/bmj.k2505
18- Bensi C, Belli S, Paradiso D, Lomurno G. Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2018 Jul; 47:923–932. DOI: 10.1016/j.ijom.2018.03.016
19- Adcock DM , Gosselin R. Direct Oral Anticoagulants (DOACs) in the Laboratory: 2015 Review. Elsevier. 2015 Mai; TR-05948: 1-6.
20- Steffenello-Durigon G, Caycedo CA, Luz FF, Burigo ACG. Orientações de manejo perioperatório e no sangramento nos pacientes em uso de anticoagulantes orais diretos (AOD). Rev Med São Paulo. 2018 Out; 97(5):476-85.
21- Ingrasciotta Y, Crisafulli S, Pizzimenti V, Marcianò I, Mancuso A, Andò G, et al. Pharmacokinetics of new oral anticoagulants:implications for use in routine care. Expert Opinion on Drug Metabolism & Toxicology. 2018 Out; 1742-5255: 1744-7607. DOI: 10.1080/17425255.2018.1530213.
22- Mauprivez C, Khonsari RH, Razouk O, Goudot P, Lesclous P, Descroix V. Management of dental extraction in patients undergoing anticoagulant oral direct treatment: a pilot study. Elsevier. 2016 Nov; 122:e146-e155
23- Reis AFM. A Importância dos Novos Anticoagulantes na Medicina Dentária. Monografia [ Mestre em Medicina Dentária] - Universidade Fernando Pessoa; 2017
24- Costantinides F, Rizzo R, Pascazio L, Maglione M. Managing patients taking novel oral anticoagulants (NOAs) in dentistry: a discussion paper on clinical implications. BMC Oral Health | 2016; 16:5. DOI 10.1186/s12903-016-0170-7
25- Sivolella S, Biagi M, Brunello G, Berengo M, Pengo V. Managing dentoalveolar surgical procedures in patients taking new oral anticoagulants. The Society of The Nippon Dental University. 2014 Dez; DOI 10.1007/s10266-015-0195-4
26- Curtin C, Hayes JM, Hayes J. Dental Implications of New Oral Anticoagulants for Atrial Fibrillation. MA Healthcare Ltd. 2014 Ago; 41: 526–531.
27- Ministério da Saúde. Dabigatrana para prevenção de acidente vascular cerebral em pacientes com fibrilação atrial não valvar e Idarucizumabe para reversão do efeito anticoagulante do Dabigatrana. Brasília, DF: CONITEC; 2018.
28- Kustos SA, Fasinu PS. Direct-Acting Oral Anticoagulants and Their Reversal Agents—An Update. MDPI Medicines. 2019 Out; 6, 103: 1-26 DOI:10.3390/medicines6040103
29- Brandão GMS, Cândido RCF, Rollo HA, Sobreira ML, Junqueira DR. Anticoagulantes orais diretos para o tratamento da trombose venosa profunda: revisão de revisões sistemáticas. Jornal Vascular Brasileiro. 2018 Dez; 17(4):310-317.
30- Sodré-Pesse M, Macedo LD, Mestriner SF, Bataglion CAN. Protocolo de atendimento odontológico a pacientes usuários de terapia antitrombótica. RFO UPF. 2018 Ago; v. 23, n. 2, p. 229-235.
31- Ambrogio RI, Levine MH. Tranexamic Acid as a Hemostatic Adjunct in Dentistry. Compend Contin Educ Dent. 2018 Jun; 39(6):392-401
32- Johnston S. A New Generation of Antiplatelet and Anticoagulant Medication and the Implications for the Dental Surgeon. MA Healthcare Ltd. 2015 Nov; 42: 840–854
33- Cabbar F, Cabbar AT, Cosansu K, Cekirdekci EI. Effects of Direct Oral Anticoagulants on Quality of Life during Peri-procedural Management for Dental Extractions. Jornal of Oral and Maxillofacial Surgery. 2018 Nov; S0278-2391(18)31301-6.
34- Elad S, Marshall J, Meyerowitz C, Connolly G. Novel anticoagulants: general overview and practical considerations for dental practitioners. John Wiley & Sons Ltd. 2015 Set; 22, 23–32 DOI:10.1111/odi.12371
35- Miclotte I, Vanhaverbeke M, Agbaje JO, Legrand P, Vanassche T, Verhamme P et al. Pragmatic approach to manage new oral anticoagulants in patients undergoing dental extractions: a prospective case-control study. Springer-Verlag Berlin Heidelberg. 2016 Nov. DOI 10.1007/s00784-016-2010-1
36- Kwak EJ, Nam S, Park K, Kim S, Huh J, Park W. Bleeding related to dental treatment in patients taking novel oral anticoagulants (NOACs): a retrospective study. Springer-Verlag GmbH Germany, part of Springer Nature. 2018 Abr. https://doi.org/10.1007/s00784-018-2458-2
37- Corcuera MM, Acitores LRM, Pintor RML , Gil EC, Vallejo GH. Dabigatran: A new oral anticoagulant. Guidelines to follow in oral surgery procedures. A systematic review of the literature. Med Oral Patol Oral Cir Bucal. 2016 Jul; 21 (6):679-88.
38- Martinez M, Tsakiris DA. Management of Antithrombotic Agents in Oral Surgery. Dentistry Journal. 2015 Out; 3, 93-101. DOI:10.3390/dj3040093
39- Manfredi M, Dave B, Percudani D, Christoforou J, Karasneh J, Dios PD. World workshop on oral medicine VII: Direct anticoagulant agents management for invasive oral procedures: A systematic review and meta-analysis. John Wiley & Sons A/S. 2019 Mar; 25(Suppl. 1):157–173. DOI: 10.1111/odi.13086
40- Precht C, Demirel Y, Assaf AT, Pinnschmidt HO, Knipper C, Hanken H et al. Perioperative Management in Patients With Undergoing Direct Oral Anticoagulant Therapy in Oral Surery – A Multicentric Questionnaire Survey. In vivo | 2019; 33: 855-862. DOI:10.21873/invivo.11550
41- Lanau N, Mareque J, Giner L, Zabalza M. Direct oral anticoagulants and its implications in dentistry. A review of literature. J Clin Exp Dent. 2017 Set; 9(11):e1346-54.
42- Magalhães AS. Anticoagulantes orais diretos e suas implicações na cirurgia oral. Monografia [Mestre em Medicina Dentária] - CESPU; 2018.
43- Shi Q, Xu J, Zhang T, Zhang B, Liu H. Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies. Frontiers in Pharmacology. 2017 Feb; 8:58. DOI: 10.3389/fphar.2017.00058
44- Yagyuu T, Kawakami M, Ueyama Y, Imada M, Kurihara M, Matsusue Y et al. Risks of Postextraction Bleeding After Receiving Direct Oral Anticoagulants Or Warfarin: A Retrospective Cohort Study. BMJ Open. 2017 Jun; 2017;7:e015952. DOI:10.1136/bmjopen-2017-015952
45- Acanfora D, Ciccone MM, Scicchitano P, Ricci G, Acanfora C, Uguccioni M et al. Efficacy and Safety of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and High Thromboembolic Risk. A Systematic Review. Frontiers in Pharmacology. 2019 Set; 10:1048. DOI: 10.3389/fphar.2019.01048
46- Graça JPA. Anticoagulantes Orais Diretos, Antídotos e possíveis Interações. Monografia [Mestre em Ciências Farmacêuticas] - Universidade de Coimbra; 2016
2- Spencer RJ, Amerena JV. Rivoroxabana in the Prevention of Stroke and Systemic Embolism in Patients with Non-Valvular Atrial Fibrillation: Clinical Implications of the ROCKET AF Trial and Its Subanalyses. Am J Cardiovasc Drugs. 2015 Jun; DOI 10.1007/s40256-015-0127-2.
3- Hupp JR. Princípios de cirurgia. In: Hupp JR, Ellis III E, Tucker MR Cirurgia Oral e Maxilofacial Contemporânea. 5º edição. São Paulo Elsevier Editora Ltda. 2009. p. 43, 46.
4- Caliskan M, Tükel H, Benlidayi M, Deniz A. Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants? Med Oral Patol Oral Cir Bucal. 2017 Set; 1;22 (6):e767-73.
5- Ruff CT, Braunwald E. Will Warfarin Ever Be Replaced? Journal of Cardiovascular Pharmacology and Therapeutics | February 18 2010
6- Bauer KA. Pros and cons of new oral anticoagulants. American Society of Hematology. 2013 Dez; 2013 (1): 464-470. https://doi.org/10.1182/asheducation-2013.1.464
7- Firriolo FJ, Hupp WS. Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. Elsevier inc. 2012 Abr; 113:431-441
8- Lababidi E, Breik O, Savage J, Engelbrecht H, Kumar R, Crossley CW. Assessing an oral surgery specific protocol for patients on direct oral anticoagulants: a retrospective controlled cohort study. International Association of Oral and Maxillofacial Surgeons. 2018 Mar; YIJOM-3895: 1-7.
9- Yoshikawa H, Yoshida M, Yasaka M, Yoshida H, Murasato Y, Fukunaga D, Shintani A, Okada Y. Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study. Int. J. Oral Maxillofac. Surg. 2019 Jan; YIJOM-4108: 1-7.
10- Miller SG, Miller CS. Direct oral anticoagulants: A retrospective study of bleeding behavior, and documentation. Wiley Oral Diseases. 2018;24:243–248. DOI: 10.1111/odi.12698
11- Mingarro-de-León A, Chaveli-López B. Alternative to oral dicoumarin anticoagulants:Considerations in dental care. Journal section: Odontostomatology for the disabled or special patients. 2013 set;5(5):e273-8. DOI:10.4317/jced.51226.
12- Berton F, Costantinides F, Rizzo R, Franco A, Contarin J, Stacchi C et al. Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study. Springer-Verlag GmbH Germany, part of Springer Nature. 2018 Nov. https://doi.org/10.1007/s00784-018-2739-9
13- Cocero N, Basso M, Grosso S, Carossa S. Direct Oral Anticoagulants (DOACs) and Medical Comorbidities in Patients Needing Dental Extractions: Management of the Risk of Bleeding. Journal of Oral and Maxillofacial Surgery. 2018 Set. DOI: 10.1016/j.joms.2018.09.024
14- Patel JP, Woolcombe SA, Patel RK, Obisesan O, Roberts LN, Bryant C et al. Managing direct oral anticoagulants in patients undergoing dentoalveolar surgery. British Dental Journal. Volume 222 No. 4. 2017 Fev; 222: 245-249. DOI: 10.1038/sj.bdj.2017.165
15- O’Connell JE, Stassen LFA. New oral anticoagulants and their implications for dental patients. Journal of the Irish Dental Association. 2014 Jul; 60 (3): 137-143.
16- Enríquez A, Baranchuk A, Corbalán R. Manejo de hemorragia asociada a anticoagulantes orales directos: estado actual de las estrategias de reversión. Rev Med Chile. 2019; 147: 73-82
17- Vinogradova Y, Coupland C, Hill T, Hippisley-Cox J. Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. The BMJ. 2018 Mai; 362:k2505. DOI: 10.1136/bmj.k2505
18- Bensi C, Belli S, Paradiso D, Lomurno G. Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2018 Jul; 47:923–932. DOI: 10.1016/j.ijom.2018.03.016
19- Adcock DM , Gosselin R. Direct Oral Anticoagulants (DOACs) in the Laboratory: 2015 Review. Elsevier. 2015 Mai; TR-05948: 1-6.
20- Steffenello-Durigon G, Caycedo CA, Luz FF, Burigo ACG. Orientações de manejo perioperatório e no sangramento nos pacientes em uso de anticoagulantes orais diretos (AOD). Rev Med São Paulo. 2018 Out; 97(5):476-85.
21- Ingrasciotta Y, Crisafulli S, Pizzimenti V, Marcianò I, Mancuso A, Andò G, et al. Pharmacokinetics of new oral anticoagulants:implications for use in routine care. Expert Opinion on Drug Metabolism & Toxicology. 2018 Out; 1742-5255: 1744-7607. DOI: 10.1080/17425255.2018.1530213.
22- Mauprivez C, Khonsari RH, Razouk O, Goudot P, Lesclous P, Descroix V. Management of dental extraction in patients undergoing anticoagulant oral direct treatment: a pilot study. Elsevier. 2016 Nov; 122:e146-e155
23- Reis AFM. A Importância dos Novos Anticoagulantes na Medicina Dentária. Monografia [ Mestre em Medicina Dentária] - Universidade Fernando Pessoa; 2017
24- Costantinides F, Rizzo R, Pascazio L, Maglione M. Managing patients taking novel oral anticoagulants (NOAs) in dentistry: a discussion paper on clinical implications. BMC Oral Health | 2016; 16:5. DOI 10.1186/s12903-016-0170-7
25- Sivolella S, Biagi M, Brunello G, Berengo M, Pengo V. Managing dentoalveolar surgical procedures in patients taking new oral anticoagulants. The Society of The Nippon Dental University. 2014 Dez; DOI 10.1007/s10266-015-0195-4
26- Curtin C, Hayes JM, Hayes J. Dental Implications of New Oral Anticoagulants for Atrial Fibrillation. MA Healthcare Ltd. 2014 Ago; 41: 526–531.
27- Ministério da Saúde. Dabigatrana para prevenção de acidente vascular cerebral em pacientes com fibrilação atrial não valvar e Idarucizumabe para reversão do efeito anticoagulante do Dabigatrana. Brasília, DF: CONITEC; 2018.
28- Kustos SA, Fasinu PS. Direct-Acting Oral Anticoagulants and Their Reversal Agents—An Update. MDPI Medicines. 2019 Out; 6, 103: 1-26 DOI:10.3390/medicines6040103
29- Brandão GMS, Cândido RCF, Rollo HA, Sobreira ML, Junqueira DR. Anticoagulantes orais diretos para o tratamento da trombose venosa profunda: revisão de revisões sistemáticas. Jornal Vascular Brasileiro. 2018 Dez; 17(4):310-317.
30- Sodré-Pesse M, Macedo LD, Mestriner SF, Bataglion CAN. Protocolo de atendimento odontológico a pacientes usuários de terapia antitrombótica. RFO UPF. 2018 Ago; v. 23, n. 2, p. 229-235.
31- Ambrogio RI, Levine MH. Tranexamic Acid as a Hemostatic Adjunct in Dentistry. Compend Contin Educ Dent. 2018 Jun; 39(6):392-401
32- Johnston S. A New Generation of Antiplatelet and Anticoagulant Medication and the Implications for the Dental Surgeon. MA Healthcare Ltd. 2015 Nov; 42: 840–854
33- Cabbar F, Cabbar AT, Cosansu K, Cekirdekci EI. Effects of Direct Oral Anticoagulants on Quality of Life during Peri-procedural Management for Dental Extractions. Jornal of Oral and Maxillofacial Surgery. 2018 Nov; S0278-2391(18)31301-6.
34- Elad S, Marshall J, Meyerowitz C, Connolly G. Novel anticoagulants: general overview and practical considerations for dental practitioners. John Wiley & Sons Ltd. 2015 Set; 22, 23–32 DOI:10.1111/odi.12371
35- Miclotte I, Vanhaverbeke M, Agbaje JO, Legrand P, Vanassche T, Verhamme P et al. Pragmatic approach to manage new oral anticoagulants in patients undergoing dental extractions: a prospective case-control study. Springer-Verlag Berlin Heidelberg. 2016 Nov. DOI 10.1007/s00784-016-2010-1
36- Kwak EJ, Nam S, Park K, Kim S, Huh J, Park W. Bleeding related to dental treatment in patients taking novel oral anticoagulants (NOACs): a retrospective study. Springer-Verlag GmbH Germany, part of Springer Nature. 2018 Abr. https://doi.org/10.1007/s00784-018-2458-2
37- Corcuera MM, Acitores LRM, Pintor RML , Gil EC, Vallejo GH. Dabigatran: A new oral anticoagulant. Guidelines to follow in oral surgery procedures. A systematic review of the literature. Med Oral Patol Oral Cir Bucal. 2016 Jul; 21 (6):679-88.
38- Martinez M, Tsakiris DA. Management of Antithrombotic Agents in Oral Surgery. Dentistry Journal. 2015 Out; 3, 93-101. DOI:10.3390/dj3040093
39- Manfredi M, Dave B, Percudani D, Christoforou J, Karasneh J, Dios PD. World workshop on oral medicine VII: Direct anticoagulant agents management for invasive oral procedures: A systematic review and meta-analysis. John Wiley & Sons A/S. 2019 Mar; 25(Suppl. 1):157–173. DOI: 10.1111/odi.13086
40- Precht C, Demirel Y, Assaf AT, Pinnschmidt HO, Knipper C, Hanken H et al. Perioperative Management in Patients With Undergoing Direct Oral Anticoagulant Therapy in Oral Surery – A Multicentric Questionnaire Survey. In vivo | 2019; 33: 855-862. DOI:10.21873/invivo.11550
41- Lanau N, Mareque J, Giner L, Zabalza M. Direct oral anticoagulants and its implications in dentistry. A review of literature. J Clin Exp Dent. 2017 Set; 9(11):e1346-54.
42- Magalhães AS. Anticoagulantes orais diretos e suas implicações na cirurgia oral. Monografia [Mestre em Medicina Dentária] - CESPU; 2018.
43- Shi Q, Xu J, Zhang T, Zhang B, Liu H. Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies. Frontiers in Pharmacology. 2017 Feb; 8:58. DOI: 10.3389/fphar.2017.00058
44- Yagyuu T, Kawakami M, Ueyama Y, Imada M, Kurihara M, Matsusue Y et al. Risks of Postextraction Bleeding After Receiving Direct Oral Anticoagulants Or Warfarin: A Retrospective Cohort Study. BMJ Open. 2017 Jun; 2017;7:e015952. DOI:10.1136/bmjopen-2017-015952
45- Acanfora D, Ciccone MM, Scicchitano P, Ricci G, Acanfora C, Uguccioni M et al. Efficacy and Safety of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and High Thromboembolic Risk. A Systematic Review. Frontiers in Pharmacology. 2019 Set; 10:1048. DOI: 10.3389/fphar.2019.01048
46- Graça JPA. Anticoagulantes Orais Diretos, Antídotos e possíveis Interações. Monografia [Mestre em Ciências Farmacêuticas] - Universidade de Coimbra; 2016
Publicado
2020-02-11
Como Citar
Cortezia, K. (2020). EXODONTIA EM PACIENTES SUBMETIDOS A TERAPIA COM OS NOVOS ANTICOAGULANTES ORAIS DIRETOS. Revista Cathedral, 2(1). Recuperado de http://cathedral.ojs.galoa.com.br/index.php/cathedral/article/view/127
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