口腔医学研究

口腔医学研究 ›› 2020, Vol. 36 ›› Issue (6): 554-557.DOI: 10.13701/j.cnki.kqyxyj.2020.06.012

• 口腔颌面外科学研究 • 上一篇    下一篇

抗凝患者拔牙采用肝素桥接与维持抗凝两种方法的效果对比

朱李军*, 李俊, 王书琴, 江穂, 王启朋, 冯航   

  1. 广东省人民医院 广东省医学科学院 口腔颌面外科 广东 广州 510080
  • 收稿日期:2019-11-05 出版日期:2020-07-03 发布日期:2020-07-06
  • 通讯作者: *朱李军,E-mail:zhulijun114@126.com
  • 作者简介:朱李军(1972~ ),男,副主任医师,博士,主要从事口腔颌面外科手术领域的临床及基础研究

A Retrospective Study of Tooth Extraction in Anticoagulant Patients with Low Molecular Weight Heparin Bridging or Maintenance of Anticoagulation

ZHU Lijun*, LI Jun, WANG Shuqin, JIANG Sui, WANG Qipeng, FENG Hang   

  1. Department of Oral & Maxillofacial Surgery, Guangdong Provincial People’s Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
  • Received:2019-11-05 Online:2020-07-03 Published:2020-07-06

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摘要： 目的: 评估长期抗凝患者采用维持抗凝与低分子量肝素桥接两种不同方法行拔牙手术后的出血及血栓栓塞并发症的差异。方法: 共有215例抗凝拔牙患者纳入研究,维持抗凝组98例,术前国际标准化比值(international normalized ratio,INR)平均为(2.56±0.45);低分子量肝素桥接治疗组117例,术前INR平均为(1.52±0.21),两组患者均为拔牙不超过3颗,拔牙创面处理采用填塞止血材料[艾微停微纤维止血胶原(海绵)]及缝合。结果: 维持抗凝组中有7例患者(7.14%),低分子量肝素桥接组中有5例患者(4.27%)出现术后轻至中度出血,差异无统计学显著(P=0.361);轻度出血患者采用局部压迫及止血材料填塞获得控制,对局部处理止血效果不佳的患者,通过注射维生素K或输注新鲜冷冻血浆后创口愈合。两组患者术后1个月均未有血栓栓塞并发症的发生。结论: 维持抗凝治疗与停用抗凝药低分子肝素桥接行简单拔牙的患者在拔牙术后出血及术后血栓栓塞的发生率并无明显差异,鉴于血栓栓塞并发症的严重后果,此类患者拔牙期间可以安全的维持抗凝治疗而并不需要停用抗凝药物使用低分子量肝素桥接治疗。

关键词: 抗凝治疗, 拔牙, 低分子量肝素桥接治疗

Abstract: Objective: To evaluate the differences of bleeding and thromboembolic complications after tooth extraction in long-term anticoagulant patients with maintenance of anticoagulation or low molecular weight heparin bridging. Methods: A total of 215 anticoagulant patients were included in the study, and 98 patients were included in the maintaining anticoagulant group, with the average preoperative international normalized ratio (INR) of 2.56±0.45. There were 117 patients in the low-molecular weight heparin bridging group, with an INR average of 1.52±0.21 on the day of operation. Each patient had no more than three teeth extracted. Local hemostatic agents (Avitene ©) and suturing of the wound were used in both groups. Results: There were 7 patients (7.14%) in the maintaining anticoagulation group and 5 patients (4.27%) in the low-molecular weight heparin bridging group who had mild to moderate postoperative bleeding (P=0.361). Patients with mild bleeding were controlled by local compression and local hemostatic agents. For patients with uncontrolled bleeding, vitamin K could be injected or fresh frozen plasma could be infused. None of the participants in either group experienced thromboembolic complications within a month after operation. Conclusion: For patients received anticoagulant therapy with simple tooth extraction, there is no obvious difference in the incidence of postoperative bleeding and postoperative thromboembolic events on maintaining anticoagulation and low molecular heparin bridge. In view of the consequences of thromboembolic complications, such patients can safely keep anticoagulant therapy and no need for low molecular heparin bridging therapy during tooth extraction.

Key words: anticoagulation therapy, tooth extraction, bridging therapy