Al-Mubarak S, Al-Ali N, Abou-Rass M, Al-Sohail A, Robert A, Al-Zoman K, Al-Suwyed A, Ciancio S
Dental Department, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia.
Br Dent J. 2007 Oct 13;203(7):E15; discussion 410-1. doi: 10.1038/bdj.2007.725. Epub 2007 Aug 10.
To examine the consequences of temporary withdrawal of warfarin and/or suturing on bleeding and healing pattern following dental extractions.
Two hundred and fourteen patients on long-term oral anticoagulation (warfarin) therapy scheduled for dental extraction were randomly divided into four groups: no suturing and discontinued (group 1) or continued warfarin (group 2), and suturing and discontinued (group 3) or continued warfarin (group 4). International normalised ratio (INR) was determined at different time points (baseline, days 1, 3 and 7).
Discontinuing warfarin reduced INR level significantly at day 1, which subsequently reached <1.5 in 96 out of 104 patients (group 1 and 3). Statistical comparisons among the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern. Interestingly, patients who received sutures showed higher but insignificant incidence of bleeding postoperatively compared to their respective controls.
Dental extractions may be safely performed for patients on anticoagulation therapy provided the INR level is kept <3.0 and effective measures of local haemostasis are administered. The decision to suture should be made on case-by-case basis, as the trauma associated with soft tissue handling might outweigh its advantages in certain situations like simple extractions.
探讨暂时停用华法林和/或缝合对拔牙后出血及愈合模式的影响。
将214例计划拔牙且正在接受长期口服抗凝（华法林）治疗的患者随机分为四组：不缝合且停用华法林（第1组）或继续使用华法林（第2组），以及缝合且停用华法林（第3组）或继续使用华法林（第4组）。在不同时间点（基线、第1、3和7天）测定国际标准化比值（INR）。
停用华法林后第1天INR水平显著降低，104例患者（第1组和第3组）中有96例随后INR降至<1.5。不同治疗组之间在出血状况或愈合模式方面的统计比较未显示出任何显著差异。有趣的是，与各自对照组相比，接受缝合的患者术后出血发生率较高，但差异无统计学意义。
对于接受抗凝治疗的患者，只要INR水平保持<3.0并采取有效的局部止血措施，拔牙可以安全进行。是否缝合应根据具体情况决定，因为在某些情况下，如简单拔牙，软组织处理相关的创伤可能超过其益处。
