阿司匹林和氯吡格雷对拔牙术后出血影响的meta分析

目的 系统评价长期口服阿司匹林和氯吡格雷对拔牙术后出血情况的影响。方法 计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WangFang Data,以及CBM数据库,搜集阿司匹林和氯吡格雷对拔牙术后出血影响的随机对照实验、队列研究。检索时限均为建库至2021年11月,不限制语言。由2位评价人员独立筛选文献、提取资料并评价纳入文献的偏倚风险后,采用RevMan5.4软件进行Meta分析。结果最后共纳入14篇研究,7篇随机对照研究,7篇队列研究。Meta分析结果显示：患者长期单一服用阿司匹林或氯吡格雷作为抗血小板治疗药物时,试验组和对照组中拔牙术后出血并发症的差异无统计学意义（P>0.05）;患者长期口服双联抗血小板药物时,试验组和对照组的差异具有统计学意义（P <0.05）;双联抗血小板治疗较单一抗血小板治疗拔牙术后出血的可能性更高,且两组差异具有统计学意义（P <0.05)。结论 拔牙术前不停用阿司匹林或者氯吡格雷并不会显著增加拔牙术后牙槽窝出血的发生,但继续应用双联抗血小板药物会增加拔牙术后出血的发生。     

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。     

华法林对老年人拔牙术后出血影响的临床观察

目的 探讨国际标准化比值(international normalized ratio,INR) ＜2.5、拔牙术前不停服抗凝剂华法林的可行性.方法 选取门诊100例拔牙术前不停服华法林且INR值＜2.5的60岁以上拔牙患者为观察组,200例拔牙术前未服抗凝及抗血小板药物的60岁以上拔牙患者为对照组,均拔除单颗非阻生牙,观察拔牙术后不同时间段的出血情况.结果 两组患者拔牙术后5、10、30 min、24h 出血发生率差异有统计学意义(P＜0.05),48 h两组均无出血发生(出血发生率为0％).结论 经规范的拔牙操作同时有术后积极的出血监控和相应的止血处理措施,老年人拔除单颗非阻生牙术前INR值＜2.5不停服华法林是可行的.     

人工心脏瓣膜置换术患者牙拔除术的临床研究

目的观察116例（170颗牙齿）心脏瓣膜置换术后长期口服华法令的患者,在暂停抗凝药物与不停抗凝药物两种情况下,拔牙术中、术后的出血情况,探讨对该类患者安全的拔牙方法。方法对116例瓣膜置换术后口服华法令抗凝治疗的患者进行拔牙手术,根据患者有无华法令的停药史,分为停药组49例（68颗）,非停药组67例（102颗）。停药组术前停药3天,术后次日恢复用药,共拔除牙齿68颗;非停药组在不中止、不减量抗凝剂的情况下进行牙齿拔除术,术后常规拔牙创牙龈缝合,共拔除牙齿102颗。结果停药组44例患者共计61颗牙齿,非停药组61例患者共计93颗牙齿,术后均无明显出血,效果良好。停药组5例7颗牙齿、非停药组6例9颗牙齿,术后出血经局部再处理后,均达到良好止血效果。停药组与非停药组术后出血率无显著性差异。结论大多数长期口服华法令的患者拔牙时可不停药、不减量,均可获得良好效果。     

΢���봫ͳ�������γ������������ĥ��������������Ƚ��о�

目的：评价微创与传统拔牙法拔除下颌阻生第三磨牙的术后愈合情况,进一步验证微创拔牙法的优越性。方法选取2010年9月至2012年10月在佛山市禅城区向阳医院·禅城区口腔医院就诊,且需要拔除中位、前倾阻生下颌第三磨牙的男性患者100例,随机分为试验组和对照组（各50例）。试验组采用微创拔牙法,对照组采用传统拔牙法。比较2组患者术后发生水肿、疼痛、张口受限等情况的差异,并记录2组患者牙槽窝骨愈合过程中的骨密度曲线图。结果试验组患者术后水肿、疼痛的发生率低于对照组（P〈0.05）,试验组患者术后第4、8、12周的牙槽窝骨密度变化值明显高于对照组患者（P〈0.01）,两组差异有统计学意义。两组患者张口受限发生率比较,差异无统计学意义（P〉0.05）。结论微创拔牙术有利于牙槽窝的愈合,值得临床推广应用。     

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。     

微创与传统拔牙法拔除下颌阻生第三磨牙术后愈合情况比较研究

目的 评价微创与传统拔牙法拔除下颌阻生第三磨牙的术后愈合情况,进一步验证微创拔牙法的优越性。方法 选取2010年9月至2012年10月在佛山市禅城区向阳医院·禅城区口腔医院就诊,且需要拔除中位、前倾阻生下颌第三磨牙的男性患者100例,随机分为试验组和对照组（各50例）。试验组采用微创拔牙法,对照组采用传统拔牙法。比较2组患者术后发生水肿、疼痛、张口受限等情况的差异,并记录2组患者牙槽窝骨愈合过程中的骨密度曲线图。结果 试验组患者术后水肿、疼痛的发生率低于对照组（P < 0.05）,试验组患者术后第4、8、12周的牙槽窝骨密度变化值明显高于对照组患者（P < 0.01）,两组差异有统计学意义。两组患者张口受限发生率比较,差异无统计学意义（P > 0.05）。结论 微创拔牙术有利于牙槽窝的愈合,值得临床推广应用。     

冠周局部注射地塞米松预防下颌第三磨牙拔除术后并发症

目的评价拔牙术前或术后行地塞米松冠周局部注射（下颌第三磨牙颊侧组织,磨牙后三角区以及咀嚼肌区）在下颌第三磨牙拔除术后肿胀,疼痛及张口受限的预防效果。 方法对240例患者的下颌第三磨牙依照阻生类型进行三种方法拔除,对三组牙拔除方式的患者分别列为实验组（拔牙术前冠周局部注射地塞米松组和拔牙术后注射地塞米松组）和对照组（拔牙术前术后均未注射地塞米松）,对患者术后第1、3、7天进行随访分析,对患者肿胀指数,疼痛程度和张口受限程度进行统计,并作统计学分析。实验组之间,以及实验组与对照组之间的比较采用卡方检验,以P<0.05为差异有统计学意义。 结果在拔牙术后第1天和第7天,术前或术后冠周局部注射地塞米松组与未注射地塞米松组在肿胀指数,疼痛程度和张口受限程度差异无统计学意义（P>0.05）;术后第3天,术前或术后冠周局部注射地塞米松组较对照组在肿胀反应中具有更好的疗效（P<0.05）,在疼痛和张口受限程度中具有一定的预防、治疗效果（P>0.05）。术前或术后冠周局部注射地塞米松对拔牙后肿痛反应及张口受限程度差异无统计学意义。 结论拔牙术前或术后冠周局部注射地塞米松可有效的预防下颌第三磨牙拔除术后肿胀、疼痛反应以及张口受限的发生。     

两种方法拔除下颌阻生智齿的效果比较

目的:对比分析下颌阻生智齿拔除中微创拔牙术与传统拔牙术的应用效果。方法 :将我院收治的108例下颌阻生智齿患者随机分为观察组54例和对照组54例。对照组患者行传统拔牙术,观察组患者行微创拔牙术。评价2组患者术后的疼痛程度及张口受限程度,统计患者术中及术后并发症的发生率。结果:观察组患者术后疼痛程度及张口受限程度的"0度+Ⅰ度"比例均高于对照组(P<0.05)。观察组患者术中出血不止、邻牙松动、牙龈撕裂、根折、舌侧骨板骨折等并发症的总发生率为11.11%,对照组为27.79%,两组比较,差异具有统计学意义(P<0.05)。同时,观察组患者术后感染、面部肿胀、干槽症并发症的总发生率为12.96%,对照组为29.63%,两组比较,差异具有统计学意义(P<0.05)。结论 :下颌阻生智齿拔除中应用微创拔牙术能有效减轻患者术后的疼痛程度及张口受限程度,并降低术中、术后并发症的发生率,相较于传统拔牙术有明显的优势。     

注射用血凝酶在抗凝血治疗患者拔牙术中的应用

目的:观察注射用血凝酶对抗凝血治疗患者拔牙创的止血效果。方法:336例需拔牙同时仍继续接受抗凝血治疗的患者,随机分为试验组与对照组各168例,试验组术前于患牙处局部软组织注射血凝酶,拔牙创口采用纱卷压迫止血,对照组直接进行拔牙术,拔牙创口采用云南白药+纱卷压迫止血。结果:试验组168例患者术后均未发生明显出血现象,有效率100%,高于对照组82.14%,经统计学分析,两者间有明显差异(P<0.01)。结论:注射用血凝酶用于抗凝血治疗患者的拔牙术中,可有效控制拔牙创口出血。     

Does low-dose aspirin therapy complicate oral surgical procedures?

BACKGROUND: The fear of uncontrolled bleeding often prompts medical practitioners to stop aspirin intake for seven to 10 days before any surgical procedure. The authors initiated this study to evaluate the effect of aspirin on bleeding in patients undergoing oral surgery. METHODS: The study group consisted of 39 patients who were scheduled to undergo dental extractions. All patients were receiving 100 milligrams of aspirin daily on a regular basis. The authors randomly divided the patients into two groups: those who stopped the aspirin therapy before the procedure and those who continued the aspirin therapy. One hour before the procedures, all patients underwent a bleeding time test. In addition, the amount of bleeding during the procedure was measured. RESULTS: The mean (+/- standard deviation) bleeding time was 1.8 +/- 0.47 minutes for patients who stopped aspirin therapy one week before the procedure. For patients who continued aspirin therapy, the bleeding time was 3.1 +/- 0.65 minutes. The difference was statistically significant (P = .004). However, both groups were within the normal bleeding time range, and in both groups, a local hemostatic method was sufficient to control bleeding. No episodes of uncontrolled intraoperative or postoperative bleeding were noted. CONCLUSION: Low-dose aspirin therapy should not be stopped before oral surgery. Local hemostasis is sufficient to control bleeding. CLINICAL IMPLICATIONS: Patients receiving aspirin therapy to prevent blood clot formation may be subject to emboli formation if the treatment is stopped. The results of this study show that aspirin therapy should be continued throughout oral surgical procedures. Local measures are sufficient to control any bleeding during surgery.     

Abstracts from other journals

A randomized controlled trial was set up to investigate whether patients who were taking warfarin and had an International Normalized Ratio (INR) within the normal therapeutic range require cessation of their anticoagulation drugs before dental extractions. Of 109 patients who completed the trial, 52 were allocated to the control group (warfarin stopped 2 days before extraction) and 57 patients were allocated to the intervention group (warfarin continued). The incidence of bleeding complications in the intervention group was higher (15/57, 26%) than in the control group (7/52, 14%) but this difference was not significant. Two patients in the study required hospital review for bleeding and all other episodes of bleeding were controlled by patients at home. Continuing warfarin when the INR is < 4·1 may lead to an increase in minor postextraction bleeding after dental extractions but we found no evidence of an increase in clinically important bleeding. As there are risks associated with stopping warfarin, the practice of routinely discontinuing it before dental extractions should be reconsidered.     

术前继续口服抗凝药对复杂牙拔除术后出血的影响

目的:探讨术前不停用抗凝药对复杂牙拔除术后出血的影响.方法:前瞻性队列研究分析2020年7月-2020年9月在合肥市口腔医院外科门诊行复杂牙拔除术[翻瓣和(或)去骨],术前继续口服抗凝药物的51例患者.按口服抗凝药物的种类分为华法林组和阿司匹林组,比较2组术后30 min、1h、24h术区出血情况.采用SPSS 17....     

Can warfarin be continued during dental extraction? Results of a randomized controlled trial

A randomized controlled trial was set up to investigate whether patients who were taking warfarin and had an International Normalised Ratio (INR) within the normal therapeutic range require cessation of their anticoagulation drugs before dental extractions. Of 109 patients who completed the trial, 52 were allocated to the control group (warfarin stopped 2 days before extraction) and 57 patients were allocated to the intervention group (warfarin continued). The incidence of bleeding complications in the intervention group was higher (15/57, 26%) than in the control group (7/52, 14%) but this difference was not significant. Two patients in the study required hospital review for bleeding and all other episodes of bleeding were controlled by patients at home. Continuing warfarin when the INR is < 4.1 may lead to an increase in minor post-extraction bleeding after dental extractions but we found no evidence of an increase in clinically important bleeding. As there are risks associated with stopping warfarin, the practice of routinely discontinuing it before dental extractions should be reconsidered.     

Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study

The aim of this study was to compare the safety of tooth extraction in patients receiving direct oral anticoagulants (DOACs) or warfarin without cessation of their antithrombotic treatment. This prospective observational study included 367 patients undergoing tooth extraction (119 receiving DOACs and 248 receiving warfarin). All extractions in DOAC patients were performed 6–7 h after taking DOACs in consideration of the half-life in blood under continued antithrombotic treatment. To examine the potential postoperative bleeding risk related to the time of extraction and the drug concentration of blood, activated partial thromboplastin time (APTT) in dabigatran and prothrombin time (PT) in rivaroxaban were measured three times after administration. A total of 390 tooth extractions were performed: 128 in the DOAC patients and 262 in warfarin patients. Postoperative bleeding occurred in four extractions (3.1%) in the DOAC group and in 23 (8.8%) in the warfarin group. There was no statistically significant difference between the two groups (odds ratio: 2.362, 95% confidence interval (CI) 0.819–6.815, p = 0.112). APTT and PT prolongation in almost all cases decreased with time after taking the medicine. Our findings suggest that interruption of DOAC therapy is not necessary for tooth extraction if the procedure is performed at least 6 h after the last dose.     

The effects of combined oral anticoagulant-aspirin therapy in patients undergoing tooth extractions: a prospective study

BackgroundThe authors conducted a study to evaluate the effect of combined oral anticoagulant–aspirin therapy on postoperative bleeding in patients undergoing tooth extractions.MethodsA total of 213 patients were divided into three groups of 71 participants each. Patients in group A received combined anticoagulant-aspirin (100-milligram prophylactic dose) therapy. Patients in group B received oral anticoagulant therapy. Patients in group C received aspirin therapy (100-mg prophylactic dose). Bleeding was marked as an “event” if it met the following criteria: the bleeding continued beyond 12 hours, patient had to call the surgeon or return to dental practice or emergency department, bleeding resolved with large hematoma or ecchymosis within the oral soft tissues, or required a blood transfusion.ResultsMean international normalized ratio (INR) (standard deviation) was 2.43 (0.61) in group A, and 2.45 (0.60) in group B. Postoperative bleeding occurred in three (4.2 percent) participants in group A, two (2.8 percent) participants in group B and no (0.0 percent) participants in group C. The authors found no statistical significance in postoperative bleeding between these three groups (χ² = 2.867, P = .238). All cases of hemorrhage were controlled easily by using local hemostatic measures.ConclusionTooth extractions can be performed safely while patients continue to receive combinedanticoagulant-aspirin therapy.Clinical ImplicationsIn patients receiving combined anticoagulant-aspirin therapy, simple tooth extractions can be performed safely without discontinuing either oral anticoagulant or antiplatelet therapy if their INRs are within therapeutic range and appropriate local hemostasis measures are provided.     

Intra-alveolar epsilon-aminocaproic acid for the control of post-extraction bleeding in anticoagulated patients: randomized clinical trial

The aim of this study was to compare the effectiveness of the intra-alveolar administration of epsilon-aminocaproic acid (EACA) and daily gentle rinsing with EACA mouthwash with that of routine postoperative procedures for the control of bleeding after tooth extraction in anticoagulated patients. A randomized clinical trial was conducted involving 52 patients submitted to 140 tooth extractions, assigned randomly to two groups. The intervention group was treated with intra-alveolar administration of EACA immediately after surgery and gentle rinsing with EACA mouthwash during the postoperative period. The control group received routine postoperative recommendations. A single episode of immediate bleeding occurred in the intervention group. Late bleeding episodes occurred in 23 procedures (16.4%): 11 (15.7%) in the intervention group and 12 (17.1%) in the control group. Among the patients with late bleeding, 18 (78.3%) events were classified as moderate and were controlled by the patient applying pressure to a gauze pack placed over the extraction socket. The remaining five cases (21.7%) required re-intervention. No statistically significant difference in the frequency of postoperative bleeding was observed between the groups. Thus, routine measures were as effective for the control of bleeding after simple tooth extractions in anticoagulated patients as the topical administration of EACA.     

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.

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。     

消炎性止血网在拔牙创止血中的临床应用

目的：评价S-105消炎性止血网在拔牙创止血中的效果。方法：将270例门急诊拔牙患者分三组进行拔牙创止血,记录5min后止血情况。第一组中实验者（100例）拔牙后直接放置止血网,对照者按常规处理;第二组因正畸原因需双侧拔牙（30例）,实验侧拔牙创放置止血网,对照侧按常规处理;第三组因拔牙后出血（40例）,在清理牙槽窝后放置止血网。结果：第一组中放置止血网止血成功率为92％,与对照组常规处理半小时后止血成功率相比无统计学差异。第二组实验侧拔牙创均完全止血,且无一例出现术后疼痛,对照侧有7例仍有出血,止血成功率为77％,4例出现术后疼痛。第三组止血成功率为77.5％。结论：消炎性止血网用于拔牙创止血,止血迅速,使用方便,效果良好。