Balevi Ben
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Dec;110(6):691-7. doi: 10.1016/j.tripleo.2010.03.018. Epub 2010 Jul 2.
The aim of this study was to determine if warfarin should be withdrawn before a single tooth extraction on a patient with a prosthetic heart valve.
A quantitative decision tree was constructed to assess the expected utility values of 2 typical strategies to manage the dental extraction on a patient currently medicated with warfarin. Probabilities and utilities for a cardiovascular accident and major bleeding from a dental extraction were taken from the literature.
The decision slightly favors withholding warfarin: generating an optimal expected utility value of 0.976 utile. This was only 0.02 utile higher than the alternative option of continuing warfarin for a dental extraction.
The decision to withhold or continue warfarin before a dental extraction depends more on the relative risk of a major bleeding between the 2 medical management strategies than on the consequences of a cardiovascular accident.
本研究的目的是确定对于有心脏人工瓣膜的患者，在进行单颗牙拔除术前是否应停用华法林。
构建了一个定量决策树，以评估当前正在服用华法林的患者进行拔牙的两种典型策略的预期效用值。心血管意外和拔牙大出血的概率及效用值取自文献。
决策略微倾向于停用华法林：产生的最佳预期效用值为0.976效用单位。这仅比拔牙时继续使用华法林的替代方案高0.02效用单位。
拔牙前停用或继续使用华法林的决策更多地取决于两种医疗管理策略之间大出血的相对风险，而非心血管意外的后果。
