抗凝/抗血小板治疗患者拔牙术后出血的研究进展

Bleeding after tooth extraction in patients receiving anticoagulation/antiplatelet therapy

对接受抗凝/抗血小板治疗的患者进行拔牙手术,常因术后出血风险较高被许多口腔颌面外科门诊医生视为禁忌。多种因素与其发生术后出血相关,但目前还未达成共识。本文以近年文献为基础,对接受抗凝/抗血小板治疗患者发生拔牙术后出血的相关因素进行综述。文献复习结果表明,服用抗血小板药物的患者术后出血风险较服用抗凝药物的患者低;抗凝药物与非甾体类抗炎药、抗抑郁药选择性5-羟色胺抑制剂和5-羟色胺-去甲肾上腺素抑制剂合用,以及术前使用抗生素时,出血风险增加。此外,特定的全身疾病如糖尿病、拔牙位点感染史、较大的手术创伤等与更高的术后出血风险有一定相关性。目前普遍认为拔牙术前不停药、术后合理运用不同的止血措施是安全可行的。未来还需要更多前瞻性的对照试验,以建立不同条件下接受抗凝/抗血小板治疗的患者进行拔牙手术时的安全体系。

Tooth extraction in patients receiving anticoagulation/antiplatelet therapy is often considered contraindi⁃cated by many oral and maxillofacial surgeons because of a higher risk of postoperative bleeding.Multiple factors con⁃tribute to postoperative bleeding,but there is no consensus.Based on recent literature,this article reviews factors relat⁃ed to bleeding after tooth extraction in patients receiving anticoagulation/antiplatelet therapy.The literature review indi⁃cates that patients taking antiplatelet drugs have a lower postoperative bleeding risk than patients taking anticoagulant drugs.Prescription of anticoagulants together with non⁃steroidal anti⁃inflammatory drugs,selective serotonin inhibitors or serotonin⁃norepinephrine inhibitors increases the risk of bleeding,so does preoperative antibiotic use increase.In ad⁃dition,systemic diseases such as diabetes,history of infection at the extraction site,and greater surgical trauma are asso⁃ciated with a higher risk of postoperative bleeding.At present,it is generally believed that it is safe and feasible to use different hemostatic measures after tooth extraction and to rationally apply different hemostatic measures after surgery.More prospective controlled trials are needed in the future to establish an assessment system for patients undergoing an⁃ticoagulation/antiplatelet therapy under different conditions during tooth extraction.