Walker Cameron
Glasgow Dental Hospital and School, Glasgow, Scotland, UK.
Evid Based Dent. 2008;9(1):7. doi: 10.1038/sj.ebd.6400559.
A randomised controlled trial (RCT) was carried out.
Patients scheduled for dental extraction were randomly divided into four groups: no suturing with either discontinued anticoagulants (group 1) or continued warfarin (group 2); and suturing with either discontinued anticoagulants (group 3) or continued warfarin (group 4). The international normalised ratio (INR) was determined at different timepoints (baseline, days 1, 3 and 7).
The status of bleeding and healing were assessed by an independent examiner blinded to the treatment protocol for the four treatment groups.
Discontinuing warfarin reduced INR level significantly at day 1, and it subsequently reached <1.5 in 96 out of 104 patients (groups 1 and 3). Statistical comparisons between the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern. Interestingly, patients who received sutures showed a higher but insignificant incidence of bleeding postoperatively compared with their respective controls.
Dental extractions may be safely performed for people who are taking 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 a case-by-case basis, as the trauma associated with soft tissue handling might outweigh its advantages in some situations, such as simple extractions.
开展了一项随机对照试验（RCT）。
计划拔牙的患者被随机分为四组：停用抗凝剂不缝合（第1组）或继续使用华法林不缝合（第2组）；停用抗凝剂缝合（第3组）或继续使用华法林缝合（第4组）。在不同时间点（基线、第1天、第3天和第7天）测定国际标准化比值（INR）。
由一名对四个治疗组的治疗方案不知情的独立检查者评估出血和愈合情况。
停用华法林在第1天时显著降低了INR水平，随后104例患者中有96例（第1组和第3组）INR降至<1.5。不同治疗组之间的统计学比较未发现出血状态或愈合模式有任何显著差异。有趣的是，接受缝合的患者术后出血发生率高于各自的对照组，但差异无统计学意义。
对于正在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。
