163例长期使用华法林或抗血小板药物患者拔牙的临床研究

目的:探讨长期使用抗凝药物的患者,拔牙围手术期使用低分子肝素钠替代抗凝的安全有效性。方法 :163例长期使用华法林或抗血小板药物且需拔牙治疗的患者,入院后即停用抗凝药物,围手术期使用低分子肝素钠替代抗凝治疗,华法林组患者INR(国际标准化比值)<2.0,及抗血小板药物组患者,均停用原药物5 d后拔牙(术前12 h停用低分子肝素钠),观察手术24 h后出血情况,分析其安全性、有效性。结果:163例患者围手术期均未出现血栓栓塞、心梗、脑梗等心脑血管并发症。口服华法林患者87例,手术后24 h出血4例;口服抗血小板药物患者76例,手术后24 h出血1例。出血风险低(5/163)。结论:长期使用华法林或抗血小板药物患者,围手术期使用低分子肝素钠替代抗凝的处理方案是安全有效的。     

长期服用抗凝药物患者拔牙围手术期的处理

对长期服用抗凝药物患者的拔牙操作,一直都被口腔颌面外科门诊医生视为禁忌。随着医疗保健水平提高和老龄化趋势,口腔颌面外科门诊出现了越来越多长期服用抗凝药物的患者。然而在如何对该类患者进行处理的问题上,人们有着不同的看法。本文以近几年相关研究为基础,从术前风险评估、术前准备、术中和术后风险及处理三方面入手,简要阐述对长期服用抗凝药物患者进行拔牙围手术期的注意事项。     

口服抗凝药物老年患者拔牙术中的临床治疗体会

目的:总结在服用抗凝药物的老年患者拔牙术中的治疗经验。方法:选择2018年1月~2019年6月口腔科就诊的46例(服用阿司匹林患者28例,波立维11例,法华林7例)长期口服抗凝药物且需要拔牙老年患者,拔牙前行凝血酶原时间和国际标准化率检测,分别在术后30分钟、1和24小时对治疗结果进行观察和分析。结果:拔牙术后30分钟出血15例,术后1小时内出血4例,术后24小时复诊出血1例。结论:INR在1.5~2.5范围,拔牙创局部止血处理,且压迫观察1小时,有效地预防抗凝治疗的老年患者在不停用抗凝药的情况下拔牙术后出血的情况。     

抗凝血与抗血小板治疗老年患者拔牙的临床研究

目的：观察抗凝血治疗和抗血小板治疗的老年患者拔牙术后出血及拔牙创的愈合,评价拔牙术后明胶海绵加缝合创口的止血效果。方法：老年患者分为抗凝血治疗需要拔牙组、抗血小板治疗需要拔牙组和随机选择需要拔牙的老年患者作正常对照。抗凝血治疗组拔牙前均进行凝血酶原时间国际标准化率检测。三组均采用局部纱布压迫止衄,比较拔牙术后出血情况,拔牙术后出血的病人采用局部明胶海绵加缝合创口处理。结果：抗凝血治疗与其他2组出血有显著性差异,3组均未出现局部不可控制的出血;3组创口愈合没有明显差别。结论：接受抗凝血治疗和抗血小板治疗的老年病人,在不停药和不减少药物剂量的情况下可以行拔牙术,明胶海绵加上局部缝合可达到止血目的。     

口服抗栓药物患者门诊拔牙围手术期管理的专家共识

血栓栓塞性疾病包括静脉血栓栓塞性疾病和动脉血栓栓塞性疾病，已成为导致全球人口死亡的第一因素，这类患者需要服用抗栓药物对血栓形成进行防治，但在接受外科手术时其出血风险随之增加。拔牙手术是口腔外科门诊最常见的手术，尽管目前普遍认为口服抗栓药物的患者行拔牙手术时无需停药，但这类患者的围手术期管理依旧困惑着大部分口腔外科医师，一些潜在的出血危险因素也需要进一步深入研究。为了提高口腔外科医师对口服抗栓药物拔牙患者的围手术期管理能力，最大程度保障患者健康，相关专家起草本共识，从术前出血风险评估、术中操作规范和术后护理等方面总结相关临床经验，以期为广大同行提供参考。     

富血小板血浆在抗凝治疗患者拔牙术中的应用

目的:评价富血小板血浆局部应用对抗凝治疗患者拔牙术后出血及拔牙创愈合的影响。方法:选择抗凝治疗需拔牙患者48例随机分为实验组和对照组,另外随机选择从未经抗凝治疗拔牙患者20例作正常对照。拔牙前均行凝血酶原时间和国际标准化率检测。拔牙术后实验组拔牙创置自体富血小板血浆,对照组和正常对照组拔牙创行明胶海绵填塞、可吸收线缝合或填塞加缝合处理,比较三组术后出血情况及拔牙创愈合情况。结果:实验组术后轻度出血1例,对照组术后中度出血1例,轻度出血3例,正常对照组术后轻度出血1例,三组均未出现严重出血病例;10 d后拔牙创软组织愈合实验组优于对照组和正常对照组。结论:富血小板血浆局部应用能有效预防抗凝治疗患者拔牙术后出血,促进拔牙创软组织早期愈合。     

持续服用抗凝药物老年患者焦虑状态对拔牙术后并发症的影响

目的:探讨牙科焦虑对持续服用抗凝药物的老年患者拔牙术后并发症的影响。方法:采用牙科焦虑症调查量表分析持续服用抗凝药物的老年拔牙患者，根据评分分为无焦虑组和有焦虑组。统计两组患者的基本信息及围手术期并发症情况。结果:纳入研究对象共73例，无焦虑组共48例，平均年龄69.5岁，焦虑组共25例，平均年龄66.5岁。两组患者在年龄分布，性别，术前患牙情况及部位，全身疾病情况均无明显差异，围手术期均未出现心血管症状。两组术后出血及疼痛病例数无统计学差异，术后感染3例均出现在焦虑组。结论:持续口服抗凝药物老年人在行口腔拔牙术后，心理状态对术后出血情况可能无影响，但是对高龄全身情况差的患者增加感染的可能性。     

抗血小板治疗患者拔牙术后出血的临床观察

目的：研究持续小剂量口服抗血小板药物阿司匹林对拔牙术后出血发生率的影响。方法：87例患者按完全随机化分组方法分为两组,治疗组45例,共拔牙88个;对照组42例,共拔牙63个。治疗组持续阿司匹林治疗。对照组拔牙术前7d停用阿司匹林。比较两组病例拔牙术后出血发生率的差异。结果：治疗组（持续阿司匹林治疗）和对照组（停止阿司匹林治疗）拔牙术后出血发生率分别为3.4%和1.6%,两组差异无统计学意义（p〉0.05）。结论：对于长期小剂量应用阿司匹林的患者,拔牙术前不必停药,适当的局部止血处理可有效避免术后严重出血并发症的发生。     

口服抗凝剂患者拔牙创缝合止血效果的观察

目的观察缝合拔牙创对口服抗凝剂患者拔牙后的止血效果。方法选择正在接受口服抗凝剂治疗且需要拔牙的患者43例,术前调整抗凝剂的抗凝强度即国际标准化比率(international normalized ratio,INR)值在2.0～3.0,随机分成两组,23例拔牙后水平褥式缝合两侧牙龈止血(缝合组),20例拔牙后不缝合(未缝合组)。31例未服用抗凝剂患者作为对照组,拔牙后不缝合创口。拔牙后均咬纱球压迫止血30 min。结果缝合组术后出血1例,出血发生率为4.35%(1/23);未缝合组术后出血6例,出血发生率为30.00%(6/20);对照组术后出血2例,出血发生率为6.45%(2/31)。3组患者出血发生率差异具有统计学意义(χ2=8.218,P=0.016);对照组与缝合组比较,差异无统计学意义(χ2=0.111,P=0.739);未缝合组与缝合组(χ2=5.165,P=0.023)、对照组(χ2=5.097,P=0.024)比较,差异均有统计学意义。结论正接受口服抗凝剂治疗的患者,调整INR值在2.0～3.0,在不停止抗凝治疗情况下,采取缝合拔牙创口措施,可有效避免拔牙后出血。     

36例人工心脏瓣膜置换术后长期抗凝患者的拔牙

本篇报道自１９９３年－１９９６年对人工心脏瓣膜置换术后服用华法令长期抗凝治疗的患者，在不中止抗凝治疗情况下，进行拔牙手术３６例，拔除５７颗牙，术前患者心功能１￣２有，凝血酶元时间在１８￣２５秒的抗凝治疗范围内，术后局部使用特效吸收性止血灵辅以局部缝合止血，除３例轻度出血外，其余病例均达到良好的止血效果，本文提示换瓣术后，患者不停抗凝，进行拔牙手术，采用局部措施控制出血的方法是可行的，本文还介绍了目     

The role of hemostatic agents after tooth extractions: A systematic review and meta-analysis

BackgroundHemostatic agents are used to control bleeding after tooth extraction and have been compared with conventional measures (that is, sutures or gauze pressure) in several studies. The objective of this systematic review was to evaluate the benefits of topical hemostatic agents for controlling bleeding after tooth extractions, especially in patients receiving antithrombotic therapy.Types of Studies ReviewedThe authors conducted a literature search in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials, including prospective human randomized clinical trials in which researchers compared hemostatic agents with conventional methods and reported the time to achieve hemostasis and postoperative bleeding events.ResultsSeventeen articles were eligible for inclusion. Hemostatic agents resulted in a significantly shorter time to achieve hemostasis in both healthy patients and patients taking antithrombotic drugs (standardized mean difference, –1.02; 95% CI, –1.70 to –0.35; P = .003 and standardized mean difference, –2.30; 95% CI, –3.20 to –1.39; P < .00001, respectively). Significantly fewer bleeding events were noted when hemostatic agents were used (risk ratio, 0.62; 95% CI, 0.44 to 0.88; P = .007). All forms of hemostatic agents (that is, mouthrinse, gel, hemostatic plug, and gauze soaked with the agent) had better efficacy in reducing the number of postoperative bleeding events than conventional hemostasis measures, except for hemostatic sponges. However, this was based on a small number of studies in each subgroup.ConclusionsThe use of hemostatic agents seemed to offer better bleeding control after tooth extractions in patients on antithrombotic drugs than conventional measures.Practical ImplicationsFindings of this systematic review may help clinicians attain more efficient hemostasis in patients requiring tooth extraction. This systematic review is registered in the PROSPERO database. The registration number is CRD42021256145.     

The Frequency of Bleeding Complications After Invasive Dental Treatment in Patients Receiving Single and Dual Antiplatelet Therapy

BackgroundThe dental literature suggests that a patient&apos;s antiplatelet medication schedule should not be altered before invasive dental procedures. The authors conducted a study to examine the frequency of bleeding complications after invasive dental procedures in patients taking antiplatelet medications.

MethodsIn a retrospective study of 43 dental patients who were receiving single or dual antiplatelet therapy, the authors conducted a chart review of patient records and examining documentation of the medical history. They collected demographic data; medical history; medication history; social history; presence of preoperative infection at any dental visit as evidenced by swelling, purulence or periapical radiolucency; number and type of invasive dental visits; emergency department visits; types of dental procedures performed; use of adjunctive perioperative local hemostatic measures (for example, topical thrombin, absorbable gelatin compressed sponge, sutures); blood products used preoperatively and postoperatively; and postoperative complications.ResultsTwenty-nine patients (67 percent) were receiving dual antiplatelet therapy. There were 88 invasive-procedure visits consisting of extractions, periodontal surgery, and subgingival scaling and root planing. The authors found no differences between patients receiving single or dual antiplatelet therapy for all variables, most notably the number of invasive-procedure visits, total extractions and adjunctive hemostatic measures. There were no documented episodes of prolonged postoperative bleeding.ConclusionsThe frequency of oral bleeding complications after invasive dental procedures was low to negligible for patients who were receiving single or dual antiplatelet therapy.Clinical ImplicationsThe risks of altering or discontinuing use of antiplatelet medications far outweigh the low risk of postoperative oral bleeding complications resulting from dental procedures.     

Risk factors for bleeding after dental extractions in patients over 60 years of age who are taking antiplatelet drugs

The aim of this retrospective, single-centre study was to identify the risk factors for bleeding after dental extractions in patients aged over 60 who were being treated with antiplatelet drugs. A total of 338 patients who fulfilled the inclusion criteria were enrolled, and their personal and clinical details, and complications with bleeding after extraction, were retrieved and recorded. There were 182 men and 156 women (mean (SD) age 72 (8) years). A total of 469 teeth were extracted, with a mean (SD) of 1.4 (0.6) teeth/patient. Seventy-seven patients (23%) developed mild, and 55 (16%) severe, bleeding postoperatively. No patient developed a major cardiovascular or cerebrovascular event. We calculated the significance of the association of different variables with the occurrence of postoperative haemorrhage using a multivariate stepwise logistic regression model. The presence of three or more coexisting conditions, a complicated tooth extraction, and the use of two antiplatelet drugs were independent risk factors, while discontinuation of antiplatelet treatment four or more days before the tooth was extracted was a protective factor. This suggests that clinicians should assess the thrombotic risk associated with the interruption of antiplatelet drugs as well as the risk of bleeding for each patient before dental extraction. Strong and effective measures for haemostasis may be preferred over blind discontinuation of antiplatelet drugs. This study is registered in the Chinese Clinical Trial Registry (No. ChiCTR1800014355).     

Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment

BACKGROUND: There is a widespread belief among dental practitioners and physicians that oral anticoagulation therapy in which patients receive drugs such as warfarin sodium must be discontinued before dental treatment to prevent serious hemorrhagic complications, especially during and after surgical procedures. OVERVIEW: The authors examine the scientific basis for properly managing the dosage of anticoagulants for dental patients who are receiving anticoagulation therapy. The authors review the appropriate laboratory test values to which dentists should refer when evaluating for dental treatment patients who are receiving anticoagulation therapy. The authors also review clinical studies, published within the past five years, that focus on the frequency and degree of hemorrhagic and related complications among dental patients who are receiving anticoagulation therapy orally to prevent thromboembolic events. CONCLUSIONS AND CLINICAL IMPLICATIONS: The scientific literature does not support routine discontinuation of oral anticoagulation therapy for dental patients. Use of warfarin sodium as it relates to dental or oral surgical procedures has been well-studied. Some dental studies of antiplatelet therapy are consistent with the findings in warfarin sodium studies. Dental therapy for patients with medical conditions requiring anticoagulation or antiplatelet therapy must provide for potential excess bleeding. Routine discontinuation of these drugs before dental care, however, can place these patients at unnecessary medical risk. The coagulation status--based on the International Normalized Ratio--of patients who are taking these medications must be evaluated before invasive dental procedures are performed. Any changes in anticoagulant therapy must be undertaken in collaboration with the patient's prescribing physician.     

Risk of postoperative bleeding following dental extractions in patients on antithrombotic treatment

IntroductionThe risk of bleeding after dental extractions in patients taking antithrombotic medication is not well known. This study aims to investigate the incidence of postoperative bleeding following dental extractions in adult patients taking antithrombotic medication in Saudi Arabia.MethodsThis retrospective study included 539 patients aged 18–93 years who attended 840 appointments for dental extractions from January 2012 to June 2016 at a tertiary care hospital in Saudi Arabia. Patients who returned with a complaint of bleeding were treated with local hemostatic measures as outpatients.Results and Conclusion: Only 1.7% of extraction appointments were associated with postoperative bleeding. The highest risk of bleeding was noted in patients receiving warfarin (3.88%), whereas those on clopidogrel had no significant risk of bleeding. Women were found to have the highest rate of bleeding, particularly those on newer oral anticoagulant medications.Dental extractions can be safely done in adults receiving antithrombotic treatment, provided established guidelines are followed; therefore, dental professionals must exercise caution when planning invasive dental treatment for patients on continued antithrombotic therapy.     

Bleeding frequency of patients taking ticagrelor,aspirin, clopidogrel,and dual antiplatelet therapy after tooth extraction and minor oral surgery

Background

Perioperative bleeding complications of ticagrelor, a newer oral antiplatelet, has not been studied in dentistry. Studies about bleeding status after oral surgical procedures in patients receiving continued antiplatelet therapy are also limited. We investigated the effects of continuing aspirin, clopidogrel, ticagrelor, or dual antiplatelet therapy on the frequency of bleeding events in patients undergoing tooth extractions or minor oral surgery.

On the use of prothrombin complex concentrate in patients with coagulopathy requiring tooth extraction

In patients on high-level anticoagulant therapy (prothrombin time-international normalized ratio [PT-INR] ≥ 4.5), surgical procedures can be carried out with bridging therapy using heparin. However, surgical treatment options are severely limited in patients on high-level anticoagulant therapy and who have heparin-induced thrombocytopenia (HIT), as heparin use is contraindicated. We performed tooth extraction using prothrombin complex concentrate (PCC) in 2 HIT patients on high-level anticoagulation therapy (PT-INR ≥ 4.5). Five hundred units of PCC were administered intravenously, and after 15 minutes, it was confirmed that PT-INR was less than 2.0. Tooth extraction was then performed and sufficient local hemostasis was achieved. At 3 hours after tooth extraction, PT-INR was 2.0 or higher and later increased to 4.0 or higher, but postoperative bleeding was mostly absent. When performing tooth extraction in HIT patients on high-level anticoagulant therapy, favorable hemostatic management was achieved through sufficient local hemostasis and transient warfarin reversal using PCC.     

Oral tyrosine kinase inhibitors in OMFS: a review

It is increasingly common in OMFS to treat patients who are taking therapeutic doses of anticoagulant or antiplatelet drugs, or both. These patients have a high risk of postoperative bleeding ranging from minor oozing that can be managed using local measures, to a major haemorrhage necessitating transfusion. The risk of bleeding associated with tyrosine kinase inhibitors (TKI) taken orally is not well-known in the specialty. We report a case series of two patients treated with them and discuss this group of drugs.