华法林对深静脉血栓形成患者拔牙术后出血的影响

Influence of wafarin on post-operative bleeding after tooth extraction in patients with deep venous thrombosis

目的探讨深静脉血栓形成（deepvenousthrombosis，DVT）患者长期口服华法林，国际标准化比值（internationalnormalizedratio，INR）控制在2．0—3．0，拔牙前不停止口服华法林的可行性。方法回顾性分析患DVT长期口服华法林行拔牙术者80例，根据INR值分为两组：2．0≤INR≤2．5组36例，2．5〈INR≤3．0组44例；另180例未患DVT且未服用华法林及抗血小板药物的患者为对照组。三组患者均拔除单颗非阻生齿，观察并记录拔牙术后5min、10min、30min、1h、24h、48h的出血情况。结果对照组与2．0≤INR≤2．5的两组患者在拔牙术后5rain、10min、30min的拔牙窝出血率比较差异均有统计学意义（P〈0．05），1h后两组出血率比较差异无统计学意义（P〉0．05），24h后两组均无再出血。2．0≤INR≤2．5与2．5〈INR≤3．0的两组患者在拔牙术后5rain、10min、30min、1h、24h的拔牙窝出血率比较差异均有统计学意义（P〈0．05），48h均未再出血。结论长期口服华法林的DVT患者，在术前不停止口服华法林的情况下拔除单颗非阻生牙是可行的，但INR尽量控制在2．0—2．5。

Objective To investigate the feasibility of continuing warfarin when international normalized ratio （INR）was between 2.0 and 3.0 before tooth extraction in the patients with deep venous thrombosis. Methods Clinical data of 80 patients with DVT and prolong use of wafarin served as observation group, 180 patients without DVT or taking wafarin and antiplatelet medicine served as control group, according to the INR, the observation group were further divided into two group：36 cases with the INR above or equal 2. 0 and below or equal 2. 5 ,and 44 cases with the INR above 2. 5 and below and equal 3.0. All the patients underwent a single non - impacted tooth extraction. Postoperative bleeding at different time（5min,10min,30min, lh,24h,48h）were observed. Results There were significant difference in postoperative bleeding at 5,10,30 min after extraction（P 〈 0. 05）and there was no significant difference at ! h between control group and the group with INR above or equal 2. 0 and below or equal 2. 5 ,no bleeding was found in either group at 24 h（inci- dence of bleeding were 0% ） ;There were significant difference in postoperative bleeding at 5,10,30 min, 1 h,24 h after extraction （P 〈 0. 05 ）between the two different INR group, no bleeding was found in either group at 48 h. Conclusion It was feasible to continue wafarin for the patients with DVT maintaining 2. 0 ≤ INR ≤ 2. 5 undergoing a single non - im- pacted tooth extraction.