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

Dental Extraction in Patients on Anticoagulant Therapy

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。

Objective：To investigate the clinical availability and security with low-molecular-weight heparin as bridging therapy in patients with long-term oral anticoagulants during dental extraction. Methods： 163 patients discontinued war-farin （87cases） or antiplatelet agents（76 cases） and used low-molecular-weight heparin as bridging therapy. The extraction procedure would proceed after the INR in patients on anticoagulants agents was 〈2.0, and discontinued antiplatelet agents for 5 days, provided the low-molecular-weight heparin was stopped twelve hours before surgery. The evaluation of the risks of bleeding or thromboembolism was included. Results： There was no thromboembolic event in the perioperative period. 4 of 87 patients on oral warfarin and 1 of 76 patients on oral antiplatelet, occurred bleeding complications after 24 hours of surgery. Low risk of bleeding was showed in the study （5/163）. Conclusion： It reveals that bridging therapy with low-molecular-weight heparin in patients with long-term oral warfarin or antiplatelet is safe and effective in the perioperative period of dental extraction.